Ambulance Insurance Quote

File Upload *

Click or drag files to this area to upload. You can upload up to 10 files.

Upload your existing policies

Insurance Renewal Date

Point of contact for your organization *

First

Last

Phone

Email *

In business for how long?

Is the company a private for-profit ambulance service?

If No, please describe:

Do you own any other businesses?

If Yes, please describe:

CheckboxesDo you require a motor carrier filing? (Ex. Form E)

If yes, please attach a copy of form.

Click or drag a file to this area to upload.

With respect to insurance for the insured, has any insurance policy been canceled or non-renewed, or an application for insurance been declined, or refused in the past five years?

If yes, please notify our broker and supply a copy of notices prior to policy issue.

Gross Annual Revenue: $

Where is your primary service area:

Does the organization service any major metropolitan areas?

Do you operate in other states?

What is your annual number of calls?

Highest level of EMS service provided:

Does the company own any aircraft or watercraft?

Does the company perform any aircraft or watercraft transportation?

Are any medical clinical services offered (ie: blood pressure screening or training)

Indicate the procedures used in the Employee Selection process:

Written Application
Physical Examination
Written Test
Road Test
Pre-Employment Drug Testing
Criminal Background Check
Reference Checks
Motor Vehicle Record Check
Other

Ambulance Insurance Quick Quote