Insurance Request Form

Acceptable MVR’s

• No more than 3 moving violations in 3 years
• No more than 1 accident and 3 moving violations in 3 years
• No more than 2 accidents and 1 moving violation in 3 years
• No major violations

Unacceptable MVRs

Drivers with any of these violations in the past three years

• Hit and Run Conviction
• Fleeing or Eluding Police
• Manslaughter or Negligent Homicide
• DUI or DWI
• Any Felony Conviction
• Racing
• Driving Under a Suspended License
• Reckless Driving

Eligible Trucks

• OTR Tractor (Class 7 or higher)

Ineligible Vehicles

• Tow trucks or wreckers
• Private passenger vehicles or mobile homes
• Commercial mini, cargo or cube vans
• Antique vehicles
• Emergency vehicles
• Vehicles garaged in AK, HI or MA (Call 402-625-7246 to discuss coverage options)