Strickland General Agency of FL                                               Commercial Transportation Filing Request

                                                                                                                                                                For SGA use only:

Agency #:    Agency Name:

Agency Contact:

Policy #:    Insured Name:

Filing Request:

Federal Highway Liability Filing:    Docket # MC    Base State:

Federal Highway Cargo Filing:      Docket # MC    Base State:

Florida Form E Liability Filing      Florida Form H Cargo Filing    Florida Oversize/Overweight

MCS-90

Other: