Fillable Dealers Open Lot Lloyds of London Phone # (Strickland Insurance Brokers)

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Dealers Open Lot Lloyds of London Phone # (Strickland Insurance Brokers)

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  • 8 check-boxes
  • 155 other fields

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LL JAN 2013 1
ASSURED WARRANTS THAT ALL STATEMENTS MADE IN THE PROPOSAL ARE TRUE, COMPLETE AND HAVE BEEN MADE TO
INDUCE UNDERWRITERS TO ACCEPT THE RISK(S) CONTAINED IN THE POLICY. ANY MISREPRESENTATION WILL VOID THE
POLICY AND FORFEIT ALL CLAIMS MADE THEREUNDER. A COPY OF THIS PROPOSAL WILL BE INCORPORATED IN THE POLICY
AND FORM THE BASIS OF THE CONTRACT BETWEEN THE UNDERWRITERS AND THE ASSURED
NOTE: THE POLICY, IF ISSUED. WILL BE SUBJECT TO LIMITS OF LIABILITY AT EACH LOCATION, A LIMIT OF ANY ONE UNIT
AND SUBJECT TO COINSURANCE
Effective Date: From ________________ to ____________________
QUESTIONS OR STATEMENTS:
New Cars Used Cars Snowmobiles/ATVs Camper Trailers Mobile Homes
Motorbikes Trucks/Tractors/Trailers/Semi-Trailers Other, Please specify _____________________________________
1. Describe Business Operations:
2. Location(s) at which Insurance applies: Location 1:_________________________________________
3. What is the Radius for Pick-up and delivery?
4. Are customers accompanied at test drives? Yes No
5. Does the insured have units which are floorplanned? Yes No
6. Any vehicle furnished for personal use? If yes, please specify:
Individual’s ______________________________
Age’s ______________________________
Driving Record ______________________________
Type and value of the vehicle ______________________________
Yes No
7. Perils required
Dealers Open Lot
Dealers Open Lot – Excl. Theft
Dealers Open Lot – Excl. Collision
Dealers Open Lot – Excl. Theft and Collision
8. How many years have you operated the business being proposed for insurance? (Include in your answer previous business of a similar nature, which may have
been operated under a different name or corporate structure stating the previous business title)
A. At the above location(s) (previous name)
________________________ ____________________________________
B. At any other location(s) (previous name)
________________________ ____________________________________
9. Nature of Location(s)
Are units stored in:
a. A closed building
b. An open lot
c. Other than above (parking lot, building with open lot or forecourt),
If so, please describe:________________________________________________________
Yes No
Yes No
Yes No
10. a) Are premises unattended at any time during the day or night? Yes No
b) Number of entrances _____________________
c) Are keys left in ignition? Yes No
If No, explain procedure of handling ______________________________
TYPE OF OWNERSHIP OF BUSINESS: (PLEASE CHECK ONE)
INDIVIDUAL
PARTNERSHIP (MARRIED COUPLE)
PARTNERSHIP (ALL OTHER)
CORPORATION
Name of applicant
Producer Code: Phone:
DBA
Name:
Address:
Address:
City:
City:
State:
Zip Code:
State:
Zip Code:
Dealers Open Lot
Lloyds of London
Phone # 888-495-4950
Fax # 888-997-9970
P.O. Box 8010
Goldsboro, NC 27533-8010
LL JAN 2013 2
11. If Open Lot
a) Is the lot completely fenced or surrounded by buildings on all four sides? Yes No
If not fenced, state what protections you have:
Front _____________________________________________________
Rear _____________________________________________________
Left Side _____________________________________________________
Right Side _____________________________________________________
b) Are exits and entrances properly supervised? Yes No
c) Height and type of fence or wall ____________________________
d) What protection against theft have you across exits and entrances? Describe fully:
_______________________________________________________________________
e) Any other protections (Lights, Dogs, Watchmen etc)
_______________________________________________________________________
12. Has your insurance been declined in the past three years? If yes, explain Yes No
______________________________________________________________
14. Owner/Employee Information
15. Previous Insurance and Loss Experience
16. Description of Furnished Unit: (Specify Truck, Tractor, Trailer, Semi)
Veh
#
Year Make/Model Body Type Loaded
GVW/Seating
Capacity
Vehicle Identification
Number
Stated
Amount
Deductible
17. Loss Payee
Veh # NAME ADDRESS CITY, STATE ZIP
APPLICANT PLEASE READ
This application, being submitted through Strickland Insurance Brokers, Inc., shall not be binding on the Underwriters unless and until a contract of insurance shall
be issued and delivered in accordance herewith and then only as of the commencement date of said Insurance and in accordance with all terms thereof and the said
Applicant hereby covenants and agrees to and with the Underwriters that the foregoing statements and answers are just, full and true exposition of all the facts and
circumstances with regard to the risk to be insured, insofar as the same are known to the Applicant, and the same are hereby made the basis and condition of the
Insurance.
APPLICANT’S SIGNATURE DATE TIME PRODUCER’S SIGNATURE
____________________________ ____________ _________ ______________________________________________
13. Limit Maximum No of
units that your
location(s) will
accommodate
Average Value
per Unit
Maximum Value
per Unit
Average No. Of
Unit
Maximum No.
Of Unit
Limit
required
Deductible
Each and every
loss/ Each and
every unit
Location 1
Owner
Employee Name Date of Birth
Driver License
Number & State
Description of violations and Accidents (Past 3 years)
Policy Period Insurance Carrier Policy #
Number
of Claims
Total
Amount
Paid Hail
Total
Amount
Paid
Windstorm
Total
Amount
Paid
Collision
Any other
Physical
loss
Open
Claims
From To
From To
From To
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Dealers Open Lot Lloyds of London Phone (Strickland Insurance Brokers)

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Completed 17 July 2021

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