Tow Truck Supplement
COLUMBIA INSURANCE COMPANY
NATIONAL INDEMNITY COMPANY
NATIONAL FIRE & MARINE INSURANCE COMPANY
NATIONAL LIABILITY & FIRE INSURANCE COMPANY
NATIONAL INDEMNITY COMPANY OF THE SOUTH
NATIONAL INDEMNITY COMPANY OF MID-AMERICA
Policy Term From:
To:
This Supplement is a part of the Application and will be relied upon
by the Company as an integral part of the Application.
IN TOW COVERAGE (to provide coverage on non-owned autos* towed by rollbacks or wreckers)
1) Limit per Vehicle $ Deductible per Auto: G 500 G 1,000 G Other
2) Number of Scheduled Tow Trucks
3) Are tractor/trailer combinations towed? G Yes G No
4) Maximum # of Units (including trailers) Towed/Hauled by Any One Power Unit
*If hauling owned units, cargo applies.
STORAGE LOCATION (specified causes of loss and collision)
1) Limit of Liability per Location $ Deductible per Auto: G 500 G 1,000 G Other
2) Number of Locations
3) Maximum Number of Customers= Autos Stored
4) Maximum Limit of Any One Covered Auto $
5) Are customers= cars stored overnight? G Yes G No
6) Is yard fenced and lighted? G Yes G No
7) Where are keys to customers= cars kept?
AUTO REPOSSESSORS (only fill out if repossessions are performed)
1) What % of Towing Operation Involves Repossession %
2) How are vehicles repossessed? Describe procedure in detail:
3) Are any vehicles driven away? G Yes G No If yes, list # of repo plates and plate number
List drivers
Is physical damage coverage requested on vehicles driven away? G Yes G No Limit $
Deductible per Auto: G 500 G 1,000 G Other
4) Are any independent contractors/subcontractors used? G Yes G No
5) How many vehicles did you repo last year? By Tow Truck
By Drive-Away Subcontractor
6) Estimate % of Repos that are: Private Passenger Autos %
Light Commercial Trucks
%
Heavy Commercial Trucks
%
Commercial Trailers
%
Other (describe)
%
100 %
7) Estimate % of Repos that are: Voluntary
% Involuntary %
8) Does applicant or any employees carry firearms? G Yes G No
9) Are police notified? G Yes G No Do they ever accompany you on a repossession? G Yes G No
If yes, before or after the fact?
10) List primary customers for which you repossess:
M-5554 (12/2010) Tow Truck Supplement Page 1 of 1
