Fillable TOW TRUCK OPERATOR QUESTIONNAIRE (Colonial General Insurance Agency, Inc)

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TOW TRUCK OPERATOR QUESTIONNAIRE (Colonial General Insurance Agency, Inc)

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GAR-SUP135-0918 Page 1 of 2
This Questionnaire is supplemental to and part of the Colony Specialty Garage Application or the Colony
Specialty Garage Renewal Application.
ALL APPLICANTS (EXCEPT VIRGINIA): BY COMPLETING THIS APPLICATION, THE APPLICANT IS APPLYING FOR COVERAGE WITH
EITHER COLONY INSURANCE COMPANY, AN AUTHORIZED SURPLUS LINES INSURER OR ARGONAUT INSURANCE COMPANY OR
ARGONAUT MIDWEST INSURANCE COMPANY, A LICENSED INSURER.
VIRGINIA APPLICANTS: BY COMPLETING THIS APPLICATION, THE APPLICANT IS APPLYING FOR COVERAGE WITH COLONY
SPECIALTY INSURANCE COMPANY, AN AUTHORIZED SURPLUS LINES INSURER.
Business Trade Name _____________________________________________________________________________
Operations
1. Are two (2) year hard copy loss runs attached? Yes No
Is there a lapse in coverage in the last two (2) years?
Yes No
2. What is your radius of operation?
0-100 miles 101-300 miles 301+ miles
3. Do you own and use transporter tags?
Yes No
If “Yes”: # _____________ Use: _______________________________________________________________
4. Have you executed any contracts with hold harmless or waiver of subrogation agreements?
Yes No
If “Yes”, to whom and why? ______________________________________________________________________
5. What is your US DOT number? ______________ What date was it issued? _____________________________
6. What filings are required? ________________________________________________________________________
If filings are required, does this insurance cover all owned, leased and operated vehicles?
Yes No
7. Do you ever hire owner/operators?
Yes No
If “Yes”, are all owner/operators scheduled on this policy?
Yes No
8. Do you subcontract your towing work?
Yes No
Do they operate under your filing? Yes No
9. What percentage of your towing is? (Select all that apply and show percentages – must total 100%)
a. Private Passenger Type Vehicles ________%
b. Light/Medium/Heavy Trucks ________%
c. Ex-Heavy Vehicles (> 26,000 GVW, including trucks, RVs and equipment) ________%
d. Watercraft (add Symbol 32 to GKL) ________%
e. Other – describe: ________________________________ ________%
10. What percentage of your towing is done for? (Select all that apply and show percentages – must total 100%)
a. For Hire Wrecker (twenty-four (24) hour towing, police rotation, etc.) ________%
b. Wrecker Repo (Any repossession operations at all) ________%
c. Wrecker with Garage Dealer (towing owned vehicles for your dealer operations) ________%
d. Wrecker with Service Operation (towing customer’s autos to your shop for service/repair) ________%
e. Wrecker with Salvage Operation (used exclusively to tow junk cars for salvage ops) ________%
11. Do you monitor police scanners to obtain business?
Yes No
TOW TRUCK OPERATOR QUESTIONNAIRE
GAR-SUP135-0918 Page 2 of 2
12. Describe your accident reporting procedures:
Garagekeepers Security
13. Describe lot security? None Fence & Gate Post & Cable In Building
Other – Describe ___________________________________________________________________________
14. Where are vehicle keys kept when the business is closed?
Key Cabinet Taken Home In/On the Vehicle
Driver Requirements
15. Do you check MVR’s on all drivers before hiring? Yes No N/A (No Employees)
16. Do you check MVR’s annually thereafter?
Yes No N/A (No Employees)
17. Do you and all your drivers have a CDL license?
Yes No
If “No”, please explain: __________________________________________________________________________
18. Do you hire drivers under age twenty-one (21)?
Yes No N/A (No Employees)
19. Do you and all your drivers have at least two (2) years experience
Yes No
driving a Tow Truck?
Tow Trucks - If this policy will not cover the schedule autos disregard this section
20. Do you have a preventative maintenance program for vehicles? Yes No
If “Yes”, who performs the maintenance?
Employees Other (describe): _____________________________
21. Any scheduled autos over twenty (20) years old?
Yes No
If “Yes”, a Vehicle Inspection is required. If physical damage coverage is provided, include photos of all four sides of
the vehicle.
22. Are all Tow Trucks equipped with emergency flashing lights
Yes No
and adequate exterior lighting?
THIS SUPPLEMENTAL APPLICATION IS INCORPORATED BY REFERENCE INTO THE PRIMARY APPLICATION
APPLICANT’S SIGNATURE DATE
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TOW TRUCK OPERATOR QUESTIONNAIRE (Colonial General Insurance Agency, Inc)

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Completed 22 August 2020

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