Truck Physical Damage Insurance
Complete this form to request a quote. We use plain language—no insurance jargon.
Complete this form to request a quote. We use plain language—no insurance jargon.
By submitting this application, you acknowledge and agree to the following:
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
Any individual who elects to place insurance coverage in the surplus lines market acknowledges and agrees that such coverage is being provided by an unauthorized (non‑admitted) insurer and not by an insurer licensed in the State of Florida. The insured further acknowledges that persons insured by surplus lines carriers are not protected by the Florida Insurance Guaranty Association or any similar state guaranty fund with respect to any right of recovery for the obligations of an insolvent unauthorized insurer. By proceeding with this placement, the insured understands and agrees that policy rates and forms used by surplus lines insurers are not approved by any Florida regulatory agency, and that the policy forms, conditions, premiums, and deductibles may differ materially from those available in the admitted market. The insured has been advised to carefully read the entire policy and understands that coverage may otherwise be available from insurers admitted to do business in Florida.
This application is for physical damage coverage only and does not include auto liability coverage.
I understand that this policy does not provide coverage for legal liability for injury to persons or damage to the property of third parties.
This application is submitted to Emblem for the purpose of obtaining a quote for physical damage coverage from a surplus lines carrier. The information provided herein will be used to complete that carrier's application, which will become part of the insurance policy if issued.
All information provided in this application is true, accurate, and complete to the best of your knowledge. You understand that any misrepresentation or omission of facts may result in the denial of coverage or cancellation of any policy issued.
You authorize Emblem Protect and its agents to verify any information provided in this application, including but not limited to contacting the FMCSA, insurance carriers, financial institutions, and other relevant parties.
You consent to the collection, storage, and processing of the personal and business information provided herein in accordance with applicable privacy laws and regulations.