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3. Does driver indoctrination include: Yes No <br /> A. Company rules and policies ® ❑ <br /> B. Daily DOT vehicle inspection procedures ® ❑ <br /> C. Equipment familiarization ❑ <br /> D. Route familiarization ® ❑ <br /> E. Emergency procedures ® ❑ <br /> F. Accident reporting procedures ® ❑ <br /> 4. Does road supervision include: Yes No <br /> A. Mechanical recording devices ❑ <br /> B. Radio dispatch ❑ <br /> 5. Are accident investigation and review procedures,including records,maintained? Z Yes ❑No <br /> 6. Do the review procedures include disciplinary procedures? Z Yes ❑No If Yes,please explain: <br /> 7. When were you last audited on site by Federal or State DOT officials? Never <br /> Attach copies of latest DOT or applicable state authority inspection reports. <br /> 8. Have you been audited by any other regulatory agencies? ❑Yes ®No If Yes,please list agency and date of audit. <br /> PRIOR CARRIER INFORMATION <br /> 1. Provide the following information for the current and past four(4)policy periods: <br /> Current Policy Prior <br /> Period Four(4)Po!!cX Periods <br /> 2016-17 202015-16 202014-15 20 20 <br /> A. Insurance Carrier Lancer Lancer Lancer <br /> B. Liability Limits 5,000,000 5,000,000 5,000,000 <br /> C. Deductible or SIR 100,000 100,000 100,000 <br /> D. Annual Premium 136,573 136,573 118,770 <br /> (1) Auto Liability <br /> (2) Physical Damage 0 0 0 <br /> 2. Has your insurance ever been obtained through an Assigned Risk Plan? ❑Yes ®No If Yes,please explain: <br /> 3. Have you ever had a gap in insurance coverage? ❑Yes ❑No If Yes,Please explain: <br /> 4. Has any company,during the past three(3)years,cancelled or refused to renew your automobile insurance coverage? ❑Yes ®No <br /> if Yes,please explain. (Not applicable in Missouri) <br /> 5. Attach currently valued loss runs from your insurance carriers for each of the past five(5)policy periods. If loss runs are not <br /> available, please state reasons why and include a signed statement specifying claims as to type, amount paid and amount <br /> reserved for each policy period. Also, provide details on any loss occurrences that exceeded $25,000 or involved a <br /> fatality or serious injury,as well as any gaps in insurance coverage. THIS INFORMATION IS MANDATORY. <br /> Lancer Bus/Long Application(09/13) Page 7 of 10 <br />