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SECTION 1: TRUCK OWNER INFORMATION

 

 

 

SECTION 2: TRACTOR INFORMATION

UNIT 1

UNIT 2

UNIT 3

 

SECTION 3: ADDITIONAL INFORMATION


 

 


 

SECTION 4: SIGNATURE


 All coverage ceases upon termination of independent Contractor Operation Agreement (ICOA) by either party. All coverage will cancel at 12:01 AM on the effective date of termination of ICOA. Coverage is canceled regardless of whether  the Independent Contractor receive written cancellation notice.