Fillable Supplemental VALET & PARKING LOT Garage & Auto

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Supplemental VALET & PARKING LOT Garage & Auto

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National Specialty Programs
Toll-Free: 800-366-5810 • Fax: 410-828-8179
Contact us: programs@ryansg.com
Supplemental
VALET & PARKING LOT
Garage & Auto Dealer Application is required in addition to this Supplemental
ALL QUESTIONS MUST BE ANSWERED IN FULL, SIGNED AND DATED BY THE APPLICANT
Name of Applicant (include DBA): ___________________________________________________________________________________
Establishment Name and Complete
Address
Parking Lot
(if different than drop-off location)
Number of Parking Spaces
Hours & Days
of Operation
1
Name:
Address:
Name:
Address:
Valet:
Self-Park:
2
Name:
Address:
Name:
Address:
Valet:
Self-Park:
3
Name:
Address:
Name:
Address:
Valet:
Self-Park:
4
Name:
Address:
Name:
Address:
Valet:
Self-Park:
5
Name:
Address:
Name:
Address:
Valet:
Self-Park:
6
Name:
Address:
Name:
Address:
Valet:
Self-Park:
VALET PARKING INFORMATION
1. Is the parking lot on their premises? Yes No
If no, show locations _____________________________________________________________________________________________
2. Do you park customer’s cars on the street? Yes No
If yes, show location ____________________________________________________________________________________________
3. Are valet spaces separate from public parking? Yes No
If yes, how are they separated?___________________________________________________________________________________
4. Do you use a 3-part ticket (Customer, dashboard, with the keys?) Yes No
5. Where do you keep the customer’s keys? __________________________________________________________________________
6. Do you refuse to give an obviously intoxicated customer his/her car keys? Yes No
If yes, do you suggest or provide alternate transportation?
Garage Valet & Parking Lot Application 031921 Page 1 of 2 RSGprograms.com
7. Do you drive customer vehicles on public streets? Yes No
Yes No
If yes, how far? Is it on streets greater than 2 lanes? Yes No
*To save this form after the fields are filled in, you will need Adobe Reader 9 or later. If you do not have version 9 or later,
please download the free tool at: http://get.adobe.com/reader/.
8. Is the lot manned by an attendant when open?
Garage Valet & Parking Lot Application 031921 Page 2 of 2 RSGprograms.com
Yes No
If no, is the lot fenced and gated for controlled access?
Yes No
9. Do you provide valet service for special events?
Yes No
If yes, number of events? _________________________________________________________________________________________
If yes, describe types of events and the parking specifics: ________________________________________________________________
_______________________________________________________________________________________________________________
UNDERWRITING INFORMATION
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
ADDITIONAL INFORMATION: ______________________________________________________________________________________
_______________________________________________________________________________________________________________
Additional Insureds (List below and include reason they are needed)
Average value per single Auto: $_____________________ Maximum value per single Auto: $ __________________
Applicant's Signature: Date:
Producer's Signature: Date:
Licensed Agent: Date:
Agent's Name: Agent License Number:
RSG National Specialty Programs is a unit of the RSG Underwriting Managers division of RSG Specialty, LLC, a Delaware limited liability company based in Illinois. RSG Specialty, LLC, is a
subsidiary of Ryan Specialty Group, LLC (RSG). RSG National Specialty Programs works directly with brokers, agents and insurance carriers, and as such does not solicit insurance from the public.
Some products may only be available in certain states, and some products may only be available from surplus lines insurers. In California: RSG Specialty Insurance Services, LLC (License #
0G97516). ©2021 Ryan Specialty Group, LLC
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Supplemental VALET & PARKING LOT Garage & Auto

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Completed 3 March 2022

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