|
SELECT DATE OF APPLICATION >>>
|
Quarter 1 - 202302/21-05/20
|
Quarter 2 - 202305/21-08/20
|
Quarter 3 - 202308/21-11/20
|
Quarter 4 - 202311/21-02/20
|
|
COMPANY NAME
|
|
AGENT
|
|
|
CONTACT NAME
|
|
|
CONTACT EMAIL
|
|
|
PHONE #1
|
|
PHONE #2
|
|
FAX
|
|
|
MAILING ADDRESS
|
|
|
CITY
|
|
STATE
|
|
ZIP
|
|
|
ANY LOSSES IN THE PAST 5 YEARS?
|
YES
NO
|
|
TOTAL # OF OWNED RAILCARS
|
|
TOTAL # RAILCARS ON THIS APPLICATION
|
|
|
Please Note: Only static locomotives eligible. This policy requires physical damage on all owned railcars/locomotives. If you wish to exclude coverage
for certain railcars/locomotives, you must include a written statement explaining the reason. Hanover’s underwriter must authorize exclusion.
|
|
|
|
COVERED PROPERTY LISTING
|
|
|
TYPE OF PROPERTY
|
REPORTING MARK / # / NAME
|
PROPERTY VALUE
|
CONTENT VALUE
|
|
#1
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#2
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#3
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#4
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#5
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#6
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#7
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#8
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#9
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
#10
|
|
|
|
|
Year, Make, Model, Condition
|
|
|
Storage Address (Street, City, State, ZIP)
|
|
|
TOTALS FROM ABOVE
|
$0.00
|
$0.00
|
|
TOTAL PREMIUM DUE
|
$0.00
|
|
|
|
LOSS PAYEE
|
|
|
|
#1
|
Name:
|
Property Listing (1-10)
|
|
Mailing Address(Street, City, State, ZIP)
|
|
|
Email:
|
|
#2
|
Name:
|
Property Listing (1-10)
|
|
Mailing Address(Street, City, State, ZIP)
|
|
|
Email:
|
|
#3
|
Name:
|
Property Listing (1-10)
|
|
Mailing Address(Street, City, State, ZIP)
|
|
|
Email:
|
|
|
|
|
|
TOTAL PREMIUM DUE
|
$0.00
|
|
If you are ready to submit this form, type your name in the box below then click SUBMIT
|
|
|
|
|
Please Note: Coverage cannot be bound until the completed application and rating are approved by the underwriter. Full payment must
accompany the application. You must be a member of RPCA to participate in the insurance program. RPCA membership
certificate is required. No refunds on premiums paid if insured cancels policy.
|
|
|
|
Policy Information for Inland Marine / Rolling Stock ONLY
|
|
If certificate holders are required, please fill out the additional form titled RPCA Inland Marine Certificate Holders.
Please indicate if they require Additional Insured or Loss Payee status.
[ Additional Insured implies they have ownership in your railcar. Loss Payee is normally given when you have a lien/loan on the
railcar/locomotive. If either apply, please indicate which railcars are involved.]
|
|
What is inland marine/rolling stock coverage?
|
|
1st party coverage for damage to your railcar caused by covered perils such as collision, overturn, derailment, fire, vandalism
windstorm, etc... Coverage is available without purchasing liability insurance.
|
|
What is included and what limits apply?
|
|
Carrier Hanover Insurance Company (A.M. Best rating - A)
|
|
Valuation Actual Cash Value
|
|
Deductibles Flat Wheel: $2,500 per occurrence Flood / Earth Quake: $10,000 per occurrence All Other: $1,000 per occurrence
|
|
Limits Policy Catastrophe Limit of Liability - $10,000,000 any one occurrence
$1,000,000 Maximum Any One Member, all railcars and related contents combined.
|
|
**Values exceeding member limits can be submitted for underwriter approval.
**The limit shown on the certificate is the individual member’s limit. It is not subject to claims
filed by other RPCA members if separate occurrences are involved.
|
|
Additional Coverage:
|
|
Newly Acquired Property
Add’l Debris Removal Expense
Fire Protective Systems
Flat Wheel Coverage
|
Up to $250,000
Up to $75,000
Up to $75,000
|
Fire Department Service Charge
Pollutant Clean-up & Removal
Rerailment Expense
Valuable Papers & Records
|
Up to $25,000
Up to $25,000
Up to $25,000
Up to $50,000
|
|
Pro-rated premiums (month/date/current term year): $75.00 minimum premium applies
|
|
02/21/22 - 05/20/22
05/21/22 - 08/20/22
|
@ $0.674 per $100
@ $0.536 per $100
|
08/21/22 - 11/20/22
11/21/22 - 02/20/23
|
@ $0.400 per $100
@ $0.263 per $100
|
|
Who do I contact in the event of a claim?
|
|
Please report all claims direct to United Shortline Insurance Services, Inc.(800) 247-2085
|