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Charles James Cayias Insurance, Inc.

2150 South 1300 East, Suite 100, Salt Lake City, UT 841006

Office: (801) 488-0085     Fax: (801) 463-6683

Contact: Jalene Dipietro - jalene@cayias.com or
Brianne Bennett - brianne@cayias.com

Adding a Driver: Information Must be Completed on Every Driver: If you are adding more drivers, please fill out an additional "Adding a Driver" form for each.

Driver Information:

All Drivers must meet the underwriting guidelines!

Sex:
Marital Status
Do you have a CDL?
Purpose of Use?
Types of Services Provided: (Check all that apply and include length of experience for each.)

Pilot/Escort Driver Certification(s)? Include a legible copy of all your Certification Card(s)

If you have Professional Liability (PL) Coverage, Certification from one of the following states, Utah, Colorado, Florida, or Oklahoma is required. If a driver does not have a certification from one of the mentioned states, the driver will not qualify for any Professional Liability Coverage.

Please provide a copy of the MVR. If a copy is not available, it will be an additional $15 for each MVR ordered through our office.

Contact Us Today!
801-488-0085

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Contact Us

2725 E Parleys Way Ste 170
Salt lake city, UT 84109

Ph: 801-488-0085 | charley@cayias.com
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