Business Name:*
State:*
Alabama
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California
Colorado
Connecticut
Delaware
Florida
Georiga
Hawaii
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington, D.C.
Do you own or lease your location?
Own - Paid Off
Own - Under Mortgage
Lease / Rent
Do you sell over the Internet?
-- Select an Option --
Yes
No
Ownership:
Corporation
LLC, LLP
Partnership
Sole-Proprietorship (Individual)
Owners Name:*
Married
Single
Contact Person:
Number of years in business:
New business
1-3 Years
3-5 Years
5-10 Years
More than 10 years
Wholesale(%)
Retail(%)
Internet(%)
If less than 3 years, prior experience in selling and buying cars then list the companies and dates you worked and postions, etc.
Business Phone Number:*
( ) -
Business Fax Number:
( ) -
Home Phone Number:
( ) -
Cell Phone Number:
( ) -
Email:*
Do you have an answeriing machine?
-- Select an Option --
Yes
No
On which phone?
Insured Premises: Location 1
Insured Premise Address:
Insured Premise City:
Insured Premise County:
Insured Premise State:
Insured Premise Zip Code:
Insured Premises: Location 2
Insured Premise Address:
Insured Premise City:
Insured Premise County:
Insured Premise State:
Insured Premise Zip Code:
What is the closest body of water?
Lake
River
Ocean
How far?
miles
Present Insurance Co.:
Date Insurance Expires
Present Insurance Co. Premium:
dollars
Previous Insurance Co.:
Previous Insurance Co. Exp. Date:
Previous Insurance Co. Premium:
dollars
List all losses/claims in the last 3 years:
Do we write your bond?
Yes
No
If no then who does?
What is the premium?
dollars
Does the insured have an active dealers license?
-- Select an Option --
Yes
No
Does everyone have a valid drivers license?
-- Select an Option --
Yes
No
Has anyone ever had an alcohol or drug related offense?
-- Select an Option --
Yes
No
Have there been any accidents or violations charged against any drivers license in the last 3 years?
-- Select an Option --
Yes
No
If yes, please explain.
Misrepresentation of driving records or traffic violations will result in policy premium surcharge or cancellation.
Is there a personal auto policy in your household? (private registered cars)
-- Select an Option --
Yes
No
Which company?
Do you operate a buy here pay here lot?
-- Select an Option --
Yes
No
/SELECT>
Do you transfer titles at time of sale?:
Yes
No
Are any operations other than auto sales conducted at your business?
-- Select an Option --
Yes
No
What percent (%) other?
What percent (%) auto sales?
Are any other businesses conducted from the same premise?
-- Select an Option --
Yes
No
Approximately how many vehicles do you sell annually?
Is tire recapping, retreding or used tire sales performed?
-- Select an Option --
Yes
No
Do you hire subcontractors (I.e. mechanics)? (need proof of insurance)
-- Select an Option --
Yes
No
Does anyone live on the business premises? (need proof of own insurance)
-- Select an Option --
Yes
No
Do salespersons always accompany customers on test drives?
-- Select an Option --
Yes
No
Are any vehicles loaned or rented to customers?
-- Select an Option --
Yes
No
Do you take in autos on consignment?
-- Select an Option --
Yes
No
What percent (%) of inventory?
Do you sell anything other than private passenger autos, vans, pickups or sport utility vehicles?
-- Select an Option --
Yes
No
If yes, what is it and what percent of your business?
Do you rebuild auto's?
-- Select an Option --
Yes
No
What percent (%) of autos rebuilt?
Do you operate a salvage yard?
-- Select an Option --
Yes
No
Do you sell used parts?
-- Select an Option --
Yes
No
Do you do any repair work?:
Yes
No
If so, is the repair work on customers' cars?:
Yes
No
Are any employees under 25 years old?
-- Select an Option --
Yes
No
If yes, who and how old?
Are any employees over 65 years old?
-- Select an Option --
Yes
No
If yes, who and how old?
Do you have any tow trucks for hire? (must have proof of coverage)
-- Select an Option --
Yes
No
Do you repossess vehicles?
-- Select an Option --
Yes
No
If yes, please explain:
Do you own or operate a haul a way vehicle or trailer over 2,000 gross vehicle weight?
-- Select an Option --
Yes
No
Is there any painting on the premises? (approved paint booth)
-- Select an Option --
Yes
No
Is there any paint and/or flammable materials stored on site? (if yes then paint must be in approved containers and in approved storage location)
-- Select an Option --
Yes
No
Do you do any welding?
-- Select an Option --
Yes
No
If so, what?
Are tanks secured to the wall or cart when not in use?
-- Select an Option --
Yes
No
Are there any dogs on business premises? (animals will be excluded)
-- Select an Option --
Yes
No
Are there underground fuel or waste storage tanks on the premises?
-- Select an Option --
Yes
No
Are there propane tanks on the premises?
-- Select an Option --
Yes
No
Classify each employee once and only once under their primary duty.
(indicate age, part time (PT) or if furnished a vehicle (F)
Garage Liability policy covers any bodily injury or property damage that may be caused by your business operations on or away from the premises. Therefore, all persons involved with your business in any way whether they drive cars or not, have an exposure under this policy and they must be listed!
Are any non-employess, including spouses, furnished a car? (not listed above)
-- Select an Option --
Yes
No
If yes, list name and age:
List all family members of owners/officers who are under the age of 21, whether or not they drive lot cars:
How are dealer plates used?
Coverage's desired:
Bodily injury & property damage CSL:
$
Personal injury protection:
$
Un/underinsured motorists
(BI&PD NC):
$
Medical payments:
$
Do you pick up or deliver vehicles beyond a 100 mile radius?
-- Select an Option --
Yes
No
Desired radius in miles:
101-300
1000+
Number of estimated trips:
What are the largest cities you enter?:
Who transports the vehicles from the auction to your lot?
Optional-physical damage limit (comprehensive & collision) --- Deductible $1000
Total cost on vehicle lot? (no antique cars, semi's or trailers)
$
Avg. # cars on lot?
$
Avg. cost per car?
$
Max cost per car?
$
Do you have a FLOOR PLAN/FINANCE COMPANY you need to add as a LOSS PAYEE?
Yes
No
Do you have a LANDLORD OR OTHER you need to add as an ADDITIONAL INSURED?
Yes
No
Optional-Garage keepers legal liability?
Lot protection type:
Post and chain
6' chain link fence
Building fully lit at night
Other:
Where are the keys to vehicles kept?
Notes: you must have the last 3 years of loss runs from your previous insurance company to bind coverage you can obtain loss runs from your present agent.
***Do not forget to check about Garage Liability Insurance or Surety Bonds***