Insurance Requirements Form
for Valley Truck Leasing.

Dear Owner / Operator Customer:

PLEASE CALL YOUR AGENT to let them know we will be calling for an insurance certificate

In order to provide proof of complete insurance coverage for our insurance company for this rental you agree to provide certificates listing:

  1. Your non-trucking or bob-tail liability policy.
  2. Your physical damage coverage policy.
  3. Your trucking company liability policy.

This certificate must include the following requirements:

  1. Insurance carrier must be admitted in the state where the vehicle is registered and rated at least A- or better by A.M. Best.
  2. $1,000,000 CSL AUTO LIABILITY including hired and non-owned. Please include any Excess/Umbrella Policy the customer may have regarding auto coverage.
    HAZARDOUS – $5,000,000 CSL AUTO LIABILITY, including hired and non-owned. Please include any excess liability/umbrella policy the customer may have regarding auto coverage.
  3. Name Valley Truck Leasing as an ADDITIONAL INSURED and LOSS PAYEE (as respects to leased/rented vehicles).
  4. List physical damage coverage with COMPREHENSIVE AND COLLISION DEDUCTIBLES no greater than $5,000 and any limits that apply.
  5. Thirty (30) day Notice of Cancellation.
  6. CERTIFICATE HOLDER MUST READ:
    Valley Truck Leasing, Inc.
    5668 Neubert Road
    Appleton, WI 54913

I have reviewed and understand and agree with the insurance requirements as listed above:

  • MM slash DD slash YYYY

  • By selecting the “Submit" button, I am signing this Agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. By selecting “ Submit” I am consenting to be legally bound by this Agreement's terms and conditions.

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