Fillable Colony Specialty Automobile Vehicle Inspection Form SelecttheappropriateYesorNoboxforthePowerUnitorTrailertoindicateifthefollowingitemsareingoodor (Strickland Insurance Brokers)

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Colony Specialty Automobile Vehicle Inspection Form SelecttheappropriateYesorNoboxforthePowerUnitorTrailertoindicateifthefollowingitemsareingoodor (Strickland Insurance Brokers)

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VehicleInspection(Ed.6/11) Page1



Colony Specialty Automobile Vehicle Inspection Form

NamedInsured________________________________________ PolicyNumber:________________________________

Address______________________________ __________________ ___________________________________________

Vehicle Description (use a separate inspection form for each vehicle inspected):

Year Make Model GVWorSeating

Capacity

SerialNumber OdometerReading

  



SelecttheappropriateYesorNoboxforthePowerUnitorTrailertoindicateifthefollowingitemsareingoodor

acceptableworkingorderorcondition.Acommentis requiredforallNoresponses.



Power unit:

1. Brakes(front&rear)

Yes No

2. BrakeLights

Yes No

3. ExhaustPipe&Muffler

Yes No

4. Headlights

Yes No

5. Horn 

Yes No

6. Mirror 

Yes No

7. Odometer

Yes No

8. SeatBelts

Yes No

9. Speedometer

Yes No

10. Steering

Yes No

11. Suspension

Yes No

12. TailLights

Yes No

13. TurnSignals

Yes No

14. Windows

Yes No

15. Wipers

Yes No

Trailer:

1. Brakes 

Yes No 

2. BrakeLights

Yes No 

3. Suspension

Yes No 

4. TailLights

Yes No 

5. Connectionw/tractor

Yes No 

6. TurnSignals

Yes No



ProvidecommentsforallNo

responses(indicatePowerUnitorTrailer,numericnumberofitemandprovidedetails).

Usepage3oftheinspectionformforanyadditionalcomments.Ifproblemhasbeenrepairedorcorrected,attac h

copyofrepairreceiptorinvoicetothisinspectionform.

_____________________________________________________________________________________ _____________

_____________________________________________________________________________

VehicleInspection(Ed.6/11) Page2



Tires (power unit or trailer):



Condition:

New Used Retreads;#ofretreads_______



TreadDepth:

 Good8/32to7/32Fair6/32to5/32 Poor4/32orless

Comments(requiredifretreadsorthetreaddepthisfairorpoor):

_____________________________________________________________________________________ ____________

____________________________________________________________________________

Overall mechanical condition of the vehicle:



Excellent Good Fair Poor

Comments(requiredifmechanicalconditionisFairorPoor):

_____________________________________________________________________________________ _____________

_____________________________________________________________________________________ _____________

Vehicle Alterations:

Yes No

Comments(requiredifanswerisYes):

_____________________________________________________________________________________ _____________

_____________________________________________________________________________________ _____________

General Appearance of Vehicle:

Excellent Good Fair Poor

Comments(requiredifappearanceisFairorPoor):

_____________________________________________________________________________________ _____________

_____________________________________________________________________________________ _____________

Important Note to insured: All necessary repairs must be completed within 30 days of the inspection or a

written explanation must be provided to your insurance carrier giving the reason for any delay to the repair of

the vehicle. A copy of the repair receipt or invoice must be provided to your insurance carrier within 30 days

of the repair to the vehicle. Failure to comply with these conditions may result in cancellation of your

insurance policy.

Inspection Facility:

By signing this inspection form you certify that you are an independent mechanic and not

an employee of the

insured. You further verify that the answers and statements provided in this form are a result of your physical

inspection of the vehicle identified in the Vehicle Description section and are correct to the best of your

knowledge.

__________________ ____________________________________ _______________________

Name of Garage Address State Inspection # (if applicable)

______________________ ____________________________________________ ____________________________

Date Inspected Name of Inspecting Mechanic (please print) Signature of Mechanic or Proprietor

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VehicleInspection(Ed.6/11) Page3



Additional comments (if any) related to items listed on pages 1 and 2 of this inspection form:

__________________________________________________________________________________

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Completed 17 July 2021

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