Administered by Travis Barlow Company
P O Box 686 – Pooler GA 31322  
Fax: 912-748-6084   800-537-7152   quote@travisbarlow.biz

Towing insurance industry leader, Travis Barlow Company, is pleased to partner with Copart, Inc. in offering an affinity insurance program that provides discounts and valuable services to Copart service providers.

Anyone applying for insurance must be properly evaluated to determine (1) if they are eligible for the program and (2) the facts that will determine rates and coverages specific to each operation. Proof of identification as a Copart service provider will be required before a policy is bound or issued.

To take advantage of the program and its benefits, fill out and submit the following quote request form or call Travis Barlow Company at 800-537-7152, and identify yourself as a Copart service provider.

The program is not currently available in AK, CT, DE, HI, ID, IA, MA, ME, NH, RI, VT or WV but please check back frequently as additional states expect to be added.
     
PURCHASER INFORMATION


BUSINESS INFORMATION
in city limits outside city limits
Legal Name of Business: Proposed Effective Date:
List ALL DBAs:
Business Structure: Individual Partnership LLC Corporation Other
Contact Name: Position: Phone Number:
Owner: Active:Yes No Years In Business:
Mailing Address: City: State: Zip:
Business Phone: Fax: Email:
Physical Location: City: State: Zip:
County
Any other locations, branch offices or storage lots: Yes NoIf so, Number of Additional Locations:
Current Insurance Carrier: Expiration Date of Current Policy:


COVERAGE SECTION
Auto Liability (CSL) $300,000 $350,000 $500,000 $750,000 $1,000,000  
Uninsured/Underinsured $50,000 $75,000 $85,000 $100,000 Same as Auto Liability Limits
Medical Payments Decline $1,000 $2,000 $5,000    
Personal Injury Protection (FL only) Decline $10,000      
General/Garage Liability Decline $300,000 $350,000 $500,000 $750,000 $1,000,000
Garage Keepers Limits Decline $10,000 $25,000 $35,000 $50,000 $75,000
$100,000 $120,000 $150,000 $175,000 $200,000 Other
Filings None MCS90 State BMC34 BMC 91  
Dealer Tags None Number of Dealer Tags


VEHICLE INFORMATION
  Year Make Model Type GVW(lbs) Comp/Coll. Original Cost New Current Value OnHook/Cargo Limits Serial Number
1
2
3
4
5
6
7
8
9
10


DRIVER INFORMATION
  Name Years Exp. Towing Date of Birth Past 3Yrs. # Moving Violation Past 3Yrs. # Accidents Drivers License Number
1
2
3
4
5
6
7
8
9
10


OPERATIONS
Are you involved with ANY of these operations?    Please answer all questions.
Towing Yes No         Voluntary Repossession Yes No
Storage Yes No         Involuntary Repossession Yes No
Service Station Yes No         Auto Transporting (Under 6Veh.) Yes No
Auto Repair Yes No         Auto Transporting (Over 6 Veh.) Yes No
Body Shop Yes No         Motor Club Towing Yes No
Salvage or Junk Yard Yes No         Boat Hauling Yes No
Car Sales Yes No         Equipment Hauling Yes No


INSURANCE HISTORY
Yes No Are all of your tow trucks insured with the same insurance carrier?
Yes No In the past five years, have you had towing insurance under another name?
    If so, provide name
Yes No In the past five years, has your insurance company cancelled or non-renewed coverage?
    If so, what year and reason .
Yes No In the past twelve months, has your insurance been cancelled for non payment of premium?


CLAIMS HISTORY
Yes No Do you have insurance company loss runs for your last three years of operation?
Yes No Have you filed any claims in the past three years?
Number of Claims:
Approximate amount paid for all claims in the last three years:


This web site may not be used to bind or issue insurance. You may not endorse, alter or amend vehicles or insurance coverage here. You may not make any changes to your insurance policy on this web site. This web site was designed for communication and insurance quoting purposes ONLY.

CA# OD25393