Form MCS-90 Endorsement for Motor Carrier Policies of Insurance for

FORM MCS-90

OMB No.: 2126-0008

Revised 06/16/2015

USDOT Number:

Expiration: 06/30/2016

Date Received:

A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current
valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information
is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and
reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.

United States Department of Transportation
Federal Motor Carrier Safety Administration

Endorsement for Motor Carrier Policies of Insurance for Public Liability
under Sections 29 and 30 of the Motor Carrier Act of 1980

FORM MCS-90
Issued to
Dated at

of

(Motor Carrier name)

12:00am
12:15
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
pm
noon
pm
midnight
am

on this

Amending Policy Number:

31st
30th
29th
28th
27th
26th
25th
24th
23rd
22nd
21st
20th
19th
18th
17th
16th
15th
14th
13th
12th
11th
10th
9th
8th
7th
6th
5th
4th
3rd
2nd
1st

day of

,

December
November
October
September
August
July
June
May
April
March
February
January

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
and
Labrador
(MotorYork
Carrier
stateIsland
or province)

2016
2015
2014
2013

Effective Date:

Name of Insurance Company:
Countersigned by:

(authorized company representative)

The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one):
This insurance is primary and the company shall not be liable for amounts in excess of $
This insurance is excess and the company shall not be liable for amounts in excess of $
underlying limit of $
for each accident.

for each accident.
for each accident in excess of the

Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of
said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA ,
to verify that the policy is in force as of a particular date. The telephone number to call is:
.
Cancellation of this endorsement may be effected by the company of the insured by giving (1) thirty-five (35) days notice in writing to
the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice),
and (2) if the insured is subject to the FMCSA’s registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to
the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC).

Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.

(continued on next page)
FORM MCS-90 Page 1 of 3

FORM MCS-90

OMB No.: 2126-0008

Revised 06/16/2015

Expiration: 06/30/2016

DEFINITIONS AS USED IN THIS ENDORSEMENT
Accident includes continuous or repeated exposure to conditions or
which results in bodily injury, property damage, or environmental
damage which the insured neither expected nor intended.
Motor Vehicle means a land vehicle, machine, truck, tractor, trailer,
or semitrailer propelled or drawn by mechanical power and used on
a highway for transporting property, or any combination thereof.
Bodily Injury means injury to the body, sickness, or disease to any
person, including death resulting from any of these.
Property Damage means damage to or loss of use of tangible
property.
The insurance policy to which this endorsement is attached
provides automobile liability insurance and is amended to assure
compliance by the insured, within the limits stated herein, as a
motor carrier of property, with Sections 29 and 30 of the Motor
Carrier Act of 1980 and the rules and regulations of the Federal
Motor Carrier Safety Administration (FMCSA).
In consideration of the premium stated in the policy to which this
endorsement is attached, the insurer (the company) agrees to pay,
within the limits of liability described herein, any final judgment
recovered against the insured for public liability resulting from
negligence in the operation, maintenance or use of motor vehicles
subject to the financial responsibility requirements of Sections
29 and 30 of the Motor Carrier Act of 1980 regardless of whether
or not each motor vehicle is specifically described in the policy
and whether or not such negligence occurs on any route or in
any territory authorized to be served by the insured or elsewhere.
Such insurance as is afforded, for public liability, does not apply
to injury to or death of the insured’s employees while engaged in
the course of their employment, or property transported by the
insured, designated as cargo. It is understood and agreed that
no condition, provision, stipulation, or limitation contained in
the policy, this endorsement, or any other endorsement thereon,

Environmental Restoration means restitution for the loss, damage,
or destruction of natural resources arising out of the accidental
discharge, dispersal, release or escape into or upon the land,
atmosphere, watercourse, or body of water, of any commodity
transported by a motor carrier. This shall include the cost of removal
and the cost of necessary measures taken to minimize or mitigate
damage to human health, the natural environment, fish, shellfish,
and wildlife.
Public Liability means liability for bodily injury, property damage,
and environmental restoration.

or violation thereof, shall relieve the company from liability or
from the payment of any final judgment, within the limits of
liability herein described, irrespective of the financial condition,
insolvency or bankruptcy of the insured. However, all terms,
conditions, and limitations in the policy to which the endorsement
is attached shall remain in full force and effect as binding between
the insured and the company. The insured agrees to reimburse
the company for any payment made by the company on account
of any accident, claim, or suit involving a breach of the terms of
the policy, and for any payment that the company would not have
been obligated to make under the provisions of the policy except
for the agreement contained in this endorsement.
It is further understood and agreed that, upon failure of the
company to pay any final judgment recovered against the insured
as provided herein, the judgment creditor may maintain an action
in any court of competent jurisdiction against the company to
compel such payment.
The limits of the company’s liability for the amounts prescribed
in this endorsement apply separately to each accident and any
payment under the policy because of anyone accident shall not
operate to reduce the liability of the company for the payment of
final judgments resulting from any other accident.

(continued on next page)
FORM MCS-90 Page 2 of 3

FORM MCS-90

OMB No.: 2126-0008

Revised 06/16/2015

Expiration: 06/30/2016

SCHEDULE OF LIMITS — PUBLIC LIABILITY
Type of carriage

Commodity transported

(1) For-hire (in interstate or foreign commerce, with a
gross vehicle weight rating of 10,000 or more pounds).

Property (nonhazardous)

(2) For-hire and Private (in interstate, foreign, or
intrastate commerce, with a gross vehicle weight rating
of 10,000 or more pounds).

Hazardous substances, as defined in 49 CFR 171.8,
transported in cargo tanks, portable tanks, or hoppertype vehicles with capacities in excess of 3,500 water
gallons; or in bulk Division 1.1, 1.2, and 1.3 materials,
Division 2.3, Hazard Zone A, or Division 6.1, Packing
Group I, Hazard Zone A material; in bulk Division 2.1 or
2.2; or highway route controlled quantities of a Class 7
material, as defined in 49 CFR 173.403.

$5,000,000

(3) For-hire and Private (in interstate or foreign
commerce, in any quantity; or in intrastate commerce,
in bulk only; with a gross vehicle weight rating of
10,000 or more pounds).

Oil listed in 49 CFR 172.101; hazardous waste,
hazardous materials, and hazardous substances
defined in 49 CFR 171.8 and listed in 49 CFR 172.101,
but not mentioned in (2) above or (4) below.

$1,000,000

(4) For-hire and Private (In interstate or foreign
commerce, with a gross vehicle weight rating of less
than 10,000 pounds).

Any quantity of Division 1.1, 1.2, or 1.3 material; any
quantity of a Division 2.3, Hazard Zone A, or Division
6.1, Packing Group I, Hazard Zone A material; or
highway route controlled quantities of a Class 7
material as defined in 49 CFR 173.403.

$5,000,000

*The schedule of limits shown does not provide coverage. The limits shown in the schedule are for information purposes only.

FORM MCS-90 Page 3 of 3

January 1, 1985
$750,000