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GARAGE QUOTE
Applicant's Name:
Mailing Address:
City  State     Zip
Phone:      Fax:  		 PROPOSED EFFECTIVE DATE:
From     To

Email:

 Years in Business      Years Management Experience

 Business Entity: Individual    Partnership    Corporation

 Describe your operation   

 Locations where you conduct Garage Operations
 1.    2.

 All Owners, Employees, Spouses & Children Furnished Autos
 (If more space is needed, please use the "Remarks" field at the bottom of this form)
Name
Date of Birth
 
Driver License Number
 
State of License
 
Furnished Auto?
 
Past 3 Years #
Job Description and/or Relationship
 
Accidents
Citations
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No


 SALES
 1. Where do you purchase vehicles?
 2. Who drives or tows vehicles to your lot?
 3. How many times per year do you drive-away more than 300 miles from point of purchase?
 4. How many vehicles do you sell per year?
 4a. How many of those are on consignment?
 5. What is your normal radius of operation?
 6. What is your sales mix?
    cars, sport utility, pickups, vans
    motorhomes
    travel trailers, mobile homes
    trucks, tractors, semi-trailers
    salvage parts
    other
 7. Describe lot security and key controls
 8. How many dealer plates do you have?
 9. Do you repossess vehicles? Yes No   
 9a. If yes, explain
 10. Do you sell Salvage titled vehicles? Yes No    
 10a. If yes, what percentage of vehicles require: cosmetic repair %,  mechanical repair %   structural repair %
 11. Do you always ride along on test drives? Yes No


 SERVICE
What percentage of your work is:
Body/Paint
%
 Muffler
%
 Sound System
  %
 Window Tint
  %
Tune up
%
 Radiator
%
 Tires
  %
 Other
  %
Transmission
%
 Wheel Alignment
%
 Upholstery
  %
 Describe:
   
Brakes
%
 Oil & Lube
%
 Wash/Detail
  %

 
Average # of units kept at your location? Number of entrances?
Average value per unit? Are entrances & exits secured after hours? YesNo
Maximum value per unit?      If so, how?
Where are the keys kept? Are entrances also used as exits? YesNo
Where are the keys kept at night? Is lot completely fenced or surrounded by buildings? YesNo
Do you have an repair shop? YesNo Type of fence?
    If yes, is it for dealer-autos only? YesNo Height of fence?
Do you own a wrecker? YesNo If not fenced, what protection do you use?
Is coverage required for Unaccompanied Test Drives? YesNo Do you have a guard dog? YesNo
Are premises unattended any time during the day? YesNo Is lot lit at night? YesNo
Are premises unattended any time during the night? YesNo Burglar system on lot? YesNo


 

 PRIOR CARRIERS
 
Current Carrier Policy Period Policy Premium
Prior Carrier Policy Period Policy Premium
Prior Carrier Policy Preiod Policy Premium

 LOSS HISTORY FOR 3 YEARS
 
Date of Loss
Amount
Description of Loss

 COVERAGE REQUESTED
Liability BI & PD or CSL   $ each accident,  $ aggregate
 Uninsured or underinsured motorist or CSL   $ each person,   $ each accident

Medical payments or PIP      $ Limit

Physical Damage: Comp $ deductible             Collision $ deductible 

Veh.
No.

Year
Make
Body Type
V.I.N.
ACV

 
Veh.
No.
GVW
Radius
Use
Loss Payee

Fire Legal Liability $50,000
 Uninsured Motorist $
Personal Injury Protection $ Per location
 Buybacks   Transit Limit $   Driveway Radius    Value per Auto $
 
 Remarks:   


 
 

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