Automotive Repair Shop Insurance

Policy Period Requested: From MM/DD/YY to MM/DD/YY

First Name

Last Name

Email Address

Phone Number

Business Name

Street Address

City

State

Zip Code

How many year have you been in this business?

How many years have you been in the Automotive Industry?

Business Entity Business Entity Individual Partnership Corporation LLC

Do you have Specialized Training or Certification? Do you have Specialized Training or Certification? Yes No

What is your Website Address?

Describe your Operations Describe your Operations Dealer Service Provider

Dealer Dealer Auction Bus Dealer Car Dealer Commercial Traler Dealer Motorcycle Dealer RV Dealer Truck Dealer Wholesaler Others

If others, please specify/describe

Service Provider Service Provider Car Service & Repair Misc. Services & Repair Repossessors Salvage Yard Tire Sales/Service Tow Truck Operator Truck Services & Repair Valet & parking Others

If others, please specify/describe

What percentage of your business involves cars, SUVs, pickups, and vans?

What percentage of your business involves commercial trucks and trailers?

What percentage of your business involves RVs (motorhomes and camping trailers)?

What percentage of your business involves motorcycles and off-road vehicles?

What percentage of your business involves construction and farming equipment?

What percentage of your business involves salvage (used) parts?

What else do you do?

Locations where you conduct Garage Operations (include Zip Code)

What other businesses uses your location?

List all owners, owner’s spouses and all employees. Also list other family members who drive your vehicles.

Prior Carrier and Loss History for 3 Years Prior Carrier and Loss History for 3 Years No Known Losses See Loss Runs

Current Carrier

Current Carrier Policy Year and Premium

Prior Carrier

Prior Carrier Policy Year and Premium

Prior Carrier

Prior Carrier Policy Year and Premium

Date of Loss, Amount, and Description of Loss

Where do you purchase vehicles? Where do you purchase vehicles? Auction Dealers Individuals

Who drives or transports vehicles to your lot? Who drives or transports vehicles to your lot? Employees Contract Drivers Transporter

If you drive or transport newly acquired autos more than 300 road miles from point of purchase to your lot, how many trips per year? If you drive or transport newly acquired autos more than 300 road miles from point of purchase to your lot, how many trips per year? 1-10 11-30 more than 31

and how far one-way for longest trip? and how far one-way for longest trip? Below 100 road miles More than 100 road miles

How many vehicles do you sell per year?

How many of those are sold over eBay or similar internet site?

How many vehicles do you sell per year on consignment?

What is your normal radius of operation?

Describe your theft barriers Describe your theft barriers None Natural Fence & Gate Post & Cable In Building

Where are vehicle keys kept when lot is closed? Where are vehicle keys kept when lot is closed? Key Cabinet Taken Home In/On the Vehicle

How many dealer plates do you have?

Do you repossess vehicles? Do you repossess vehicles? Yes No

Do you repair “salvage titled” vehicles prior to sale? Do you repair “salvage titled” vehicles prior to sale? Yes No

Do you always ride along on test drives? Do you always ride along on test drives? Yes No

Do you sell gasoline or LPG? Do you sell gasoline or LPG? Yes No

Do you install hitches? Do you install hitches? Yes No

If you paint, do you have a spray paint booth/room? If you paint, do you have a spray paint booth/room? Yes No

Do you sell or service Tires? Do you sell or service Tires? Yes No

Do you tow for hire? Do you tow for hire? Yes No

Do you pick-up and deliver customers vehicles? Do you pick-up and deliver customers vehicles? Yes No