Business Name:*  
                       
                    
                      State:*  
                      Alabama 
Alaska 
Arizona 
Arkansas 
California 
Colorado 
Connecticut 
Delaware 
Florida 
Georiga 
Hawaii 
Idaho 
Illinois 
Indiana 
Iowa 
Kansas 
Kentucky 
Louisiana 
Maine 
Maryland 
Massachusetts 
Michigan 
Minnesota 
Mississippi 
Missouri 
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 
                       
                         
                    
                      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 
                      $  
                    
                      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: 
                       
                    
                      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***