Fillable Used Car Dealer & Service Application (All Risks, Ltd)

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Used Car Dealer & Service Application (All Risks, Ltd)

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All Risks, Ltd. – National Specialty Programs
2555 Kingston Road, Suite 250 | York, PA 17402
Toll Free: 800-723-1022 | Phone: 717-600-0417 | Fax: 717-441-3784
www.allrisks.com
Contact us at programs@allrisks.com
Garage Application
PRODUCER INFORMATION:
Producer Name: _________________________________________ Agency Name: _________________________________________________
Phone Number: ___________________________________________ Mailing Address: ________________________________________________
City: _______________________________________________ State: ____________________________ Zip: ________________________________
ACCOUNT INFORMATION:
Account name: __________________________________________________________________________________________________________
Effective date: __________________________________ Expiration date: _________________________________________________
Mailing address: _________________________________________________________________________________________________________
City: _____________________________________ State: _______________ Zip code: ______________________________________________
County: ________________________________________ Normal Business Hours: ___________________________________________
Fein #: _________________________________________ Dealership License Number: ________________________________________
Insured Email Address: _______________________________________________________________________________________________________
Website address: _________________________________________________________________________________________________________
Contact name: _____________________________________ Contact Phone Number: ___________________________________________
Years in business: ___________________ Annual sales: $___________________________ (Required for Service Risks)
*If less than 3 years, please provide industry experience: __________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
*What positions have been held? _____________________________________________________________________________________________
_________________________________________________________________________________________________________________________
LINES OF BUSINESS: Property Garage/ Auto IM Crime Umbrella
For IM, Crime or Umbrella please include applicable ACORD Application
LEGAL STATUS: Individual Partnership Corporation LLC Other _________________
DESCRIPTION OF OPERATIONS:
Non-Franchise Dealer _________________ Non-Dealer _________________
% Retail Sales _________________ % Wholesale Sales _________________ (Complete Wholesale Questionnaire)
Non-Dealer (Please describe operation) _______________________________________________________________________________________
________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
NSP Garage Application 10.16 Page 1 of 8
LOCATION INFORMATION (For Additional Locations, copy this page)
LOCATION # _______________
Address: _______________________________________________________________________________________________________
City _______________________________________________ State ___________________ Zip ______________________________
LOCATION # _______________
Address: _______________________________________________________________________________________________________
City _______________________________________________ State ___________________ Zip ______________________________
GARAGE RATING INFORMATION
COVERAGE
LIMITS/DEDUCTIBLES
LIABILITY
Personal Injury Include Exclude
Damage to Rented Premises Include Exclude
Each Accident Limit: $ ____________________________
Aggregate Limit: $ ____________________________
Deductible: $ ____________________________
Damage to Rented Premises Limit: $ __________________
PIP
Yes No
UNINSURED/UNDERINSURED MOTORISTS Limit $ __________________________
TOTAL # OF PLATES _______ Dealer ________ Transporter ________
***NOTE: THIS INFORMATION IS NEEDED TO RATE UNINSURED/UNDERINSURED MOTORISTS COVERAGE
MEDICAL PAYMENTS Limit $ __________________________
Garage Operations _______________ Auto _____________ Both _____________
GARAGEKEEPERS:
Limit Maximum Limit Per Auto Comprehensive Deductible Collision Deductible
$
$
$
$
$
$
$
$
Direct Primary Direct Excess Legal Liability
Storage In: Standard Open Lot Non Standard Open Lot Building
Are Vehicles Stored Overnight? Yes No
DEALERS OPEN LOT:
Limit Maximum Limit Per Auto Comprehensive Deductible Collision Deductible
$
$
$
$
$
$
$
$
False Pretense Limit: $ __________________
Storage In: Standard Open Lot Non Standard Open Lot Building
Lots Lit Key Storage After Hours
NSP Garage Application 07.16 Page 2 of 8
Standard Open Lot: Open parking or storage lots enclosed on all sides by a metal cyclone fence not less than six feet in height or bounded on one or
more sides by the wall or walls of a building with no unprotected opening and with exposed sides of the lot enclosed by a metal cyclone or equivalent
fence not less than six feet in height, with opening securely locked when unattended.
Non-Standard Open Lot: Any other type of protection or fencing or unprotected lot.
INTERESTS TO BE COVERED FOR AUTOS HELD FOR SALE
Owned
Autos
Owner's interest
in financed autos
Owner &
Creditor Interest
Consigned Autos
Additional Garage Coverage:_______________________________________________________________________________________
_______________________________________________________________________________________________________________
GARAGE/AUTO COVERAGE INFORMATION
Dealers Errors & Omissions
Odometer
Title E&O
Truth-In-Lending
Agent's E&O
Include Exclude
Include Exclude
Include Exclude
Include Exclude
Limit $ ____________ Deductible $ ______________
Limit $ ____________ Deductible $ ______________
Limit $ ____________ Deductible $ ______________
Limit $ ____________ Deductible $ ______________
EMPLOYEE LIST -(Please Refer to Employee List Key Below)
Violations or Accidents
Last 3 Years
Last Name
First Name
State
License #
Accidents
Minor Violations
Birthdate
Vehicle Use*
Position/Status*
Have any drivers been convicted of a major violation in the last 3 years? Yes No
If Yes, list drivers: _____________________________________________________________________________________________
EMPLOYEE LIST KEY*
Vehicle Use: A = Furnished for Personal Use B = Empl not furnished but uses for business C = Non-Driving
D = Non-empl w/ occasional access to business vehicles E = Operates customer's vehicles
Position: 1 = Owner , Active Partner 2 = Inactive Partner 3 = Manager 4 = Sales 5 = Lot Person/Mechanic
6 = Clerical 7 = Spouse 8 = Child 9 = Occasional Driver 10 = Other
Status: F = Full Time ( over 20 Hrs. per week) P = Part Time (20 Hrs. or less per week) N = Non-Employee
FOR CONSIGNED AUTOS - WE WILL NEED
COPY OF CONSIGNMENT AGREEMENT
NSP Garage Application 07.16 Page 3 of 8
VEHICLE SCHEDULE IF YOU HAVE SCHEDULED VEHICLES
Vehicle #
Year
Make
Body Type
VIN
ACV
GVW
Filings Required
Coverage Desired? Y/N
Vehicle #
Radius
Use
Yes/No
State/Federal
Liability
Physical Damage
Deductible
Loss Payee
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Loss payee name & address _________________________________________________________________________________________________
SURVEY OF HAZARDS
General Underwriting Questions
1. Does applicant have an established store front? Yes No
2. Does applicant share premises with any other occupants? Yes No
If yes, describe: ___________________________________________________________________________________________
3. Any animals on premises? Yes No
If yes, what type __________________________________________________________________________________________
4. Is applicant a subsidiary of another entity or have any subsidiaries? Yes No
If yes explain: _____________________________________________________________________________________________
5. Does applicant sub contract any work including repair of vehicles held for sale? Yes No
If yes explain: _____________________________________________________________________________________________
6. Has coverage been declined, canceled or non-renewed in last 3 years? Yes No
If yes explain: _____________________________________________________________________________________________
7. Does applicant have any other business ventures not included in this submission? Yes No
If yes explain: _____________________________________________________________________________________________
8. Has applicant had a foreclosure, repossession or bankruptcy in the last 5 years? Yes No
If yes explain: _____________________________________________________________________________________________
9. Has applicant had a judgment in the last 5 years? Yes No
If yes explain:_____________________________________________________________________________________________
10. Are there annually serviced, charged and operable fire extinguishers on premises? Yes No
11. Does applicant store all flammable liquids in a UL listed fire cabinet? Yes No
12. Does applicant use UL listed metal containers with self closing lids? Yes No
13. Are no smoking signs posted? Yes No
14. General Housekeeping Practices Moderate Formal Informal
15. Employee Safety Training Practices Moderate Formal Informal
16. Describe type of mechanic certification (i.e.: ASE certified) _________________________________________________________________
17. Describe Key Control Procedures: ______________________________________________________________________________________
18. Does applicant have above ground or underground gasoline storage tanks? Yes No
If yes, please describe including age and construction and protection for above ground tanks: ______________________________
__________________________________________________________________________________________________________
19. Do you export vehicles out of the United States? Yes No
If yes, is the title transferred prior to shipping? Yes No
20. Do you sell autos with salvage titles? Yes No
If yes, please explain: _______________________________________________________________________________________
NSP Garage Application 07.16 Page 4 of 8
21. Do you sponsor any racing vehicles or work on racing vehicles? Yes No
If yes, explain: _____________________________________________________________________________________________
22. Do you do any towing for your business? Yes No
23. Do you tow for hire? Yes No
24. Do you use an application in your hiring process? Yes No
25. Do you check references? Yes No
26. Do you run MVR’s prior to hire for drivers or anyone who is furnished a vehicle? Yes No
27. Do you repossess autos for yourself or others? Yes No
28. Do you use a title verification company? Yes No
If yes, provide name of company: ______________________________________________________________________________
29. If you are a buy here/pay here operation, do you:
a. Transfer titles to buyer’s name at time of sale? Yes No
b. Hold title as lienholder only for final payment? Yes No
c. Require a proof of insurance from the buyer? Yes No
PRIOR CARRIER/LOSS HISTORY
(minimum currently valued expiring plus 3 years)
Carrier
Policy Term
Loss Date
Description of Loss
Amount Paid
Amount
Reserved
Policy
Premium
TYPES OF VEHICLES SOLD AND/OR REPAIRED
Sales %
Repair %
Types of Vehicles
%
%
Private Passenger Autos, Pickups, Vans, SUVs
%
%
RVs Motorhomes, Campers Complete Supplement)
%
%
Heavy Truck/Semi Trailers (Complete Supplement)
%
%
Boats (Describe): _______________________________________________________________
%
%
Power Sports (Jet Skis, ATVs, UTVs)
%
%
Motorcycles (Complete Supplement)
%
%
Golf Carts
%
%
Antique or Classic Cars
%
%
Bucket Trucks, Man Lifts
%
%
Contractors Equipment (Describe): ________________________________________________
%
%
Agricultural Equipment
%
%
Emergency Vehicles (Describe): ___________________________________________________
%
%
Buses (list all types): ____________________________________________________________
%
%
Trailers (other than semi)
%
%
Other (Describe): _______________________________________________________________
%
%
Total percentage of operations combined should equal 100%
NSP Garage Application 07.16 Page 5 of 8
DEALERSHIP OPERATIONS
1. Is applicant part of the National Independent Auto Dealers Association or a Certified Master Dealer? Yes No
2. Does applicant sell autos on consignment? Yes No
If yes, please provide a copy of the consignment agreement
3. How many vehicles are sold per year on consignment? __________________
4. Does applicant operate as an Auto Auction? Yes No
5. Are all test drives accompanied by an employee? Yes No
6. Are copies of driver’s licenses & insurance ID cards made prior to any test drive? Yes No
7. Is the test drive route limited to all right-hand turns? Yes No
8. Are overnight test drives allowed? Yes No
9. How many vehicles are sold per month? _____________________
10. Do you require Demo Agreements for anyone furnished a Demo? Yes No
If yes, does the agreement include a deductible provision? Yes No
11. Who transports vehicles to your location for sale after acquisition? ____________________________________________________
12. Maximum Radius of Pick Up & Delivery ______________________ # of Trips _________________ # of Employees _____________
13. What type of repair work is commonly completed on vehicles held for sale? _____________________________________________
14. Does applicant rent, lease or loan vehicles? Yes No
NON-DEALER OPERATIONS - Provide approximate percentage for all operations - Total must equal 100%
Airbag install, service or repair __________% Mobile Auto Repair __________%
Alarm, Stereo or Navigation Systems __________% Oil/Lube Services __________%
Auto Dismantling/Salvage Yard __________% Parking Lots & Garages (Self Park) __________%
Body Shop: (see questions below) Parts Sales (Uninstalled) __________%
Brake Repair __________% Gross Receipts $__________
Car Wash - Full Service __________% Parts Manufacturing/Rebuilding __________%
Convenience Store __________% Gross Receipts $___________
Gross Receipts: $__________ Describe Parts:________________________________________________
Detailing: __________% Performance Enhancements __________%
Maximum pick up delivery distance: _________________ Any turbo or nitrous installation? Yes No
Driveaway Contractor Services: __________% Tire Sales/Service (Complete Supplement) __________%
Frame Straightening, Cutting __________% Trailer Hitch Installation __________%
Welding (See Questions below) Bolt On __________% Welded __________%
Fuel Tank Repair __________% Transmission __________%
Gasoline Station - Full Service __________% Upholstery __________%
Gallons of Gas sold annually $__________ Valet Parking (complete supplement) __________%
Ignition Interlock Systems __________% Vehicle Conversions - Structural: __________%
Impound Yards __________% Welding __________%
Lift/Lowering Kits __________% Window Tinting __________%
Machine Shop Rebuilding __________% Windshield Installation/Repair __________%
Other (Describe): ________________________________________________________________________________________________
PAINT AND BODY SHOP OPERATIONS
1. Is spray booth NFPA compliant? Yes No
2. Are booth and paint mixing area protected by an automatic sprinkler or dry suppression system? Yes No
3. Is paint mixing area enclosed in a non-combustible enclosure with a self-closing door? Yes No
4. Do both and paint mixing area have explosion proof electrical systems? Yes No
5. Are all filters regularly cleaned and changed? Yes No
6. Maximum gallons of flammable solvent based liquid maintained at any one time? __________________________________________
FRAME STRAIGHTENING OPERATIONS
Provide year, make and model of frame machine _____________________________________________________________________
NSP Garage Application 07.16 Page 6 of 8
PROPERTY- For additional locations copy this page
Subject of Insurance Amount
Co-Insurance
Percent
Protection
Class
Valuation:
ACV or RC
Coverage Form:
Basic, Broad or
Special
Deductible
Bldg. Coverage
Bldg. 1
Bldg. 2
Bldg. 3
$_______
$ ______
$ ______
$_______
$ ______
$ ______
Business Personal Property
Bldg. 1
Bldg. 2
Bldg. 3
$_______
$ ______
$ ______
$_______
$ ______
$ ______
Business Income
Bldg. 1
W/ Extra Expense
W/O Extra Expense
Bldg. 2
W/ Extra Expense
W/O Extra Expense
Bldg. 3
W/ Extra Expense
W/O Extra Expense
$ ______
$ ______
$ ______
$ ______
$ ______
$ ______
Monthly Limit of Indemnity
1/3rd
1/4th
1/6th
Maximum Period of
Indemnity
BUILDING INFORMATION:
Building
No.
Year Built
Building
Construction
Total Sq. Ft.
Occupied
No. of
Stories
Sprinkler
System Yes/No
Fire Protection
System Yes/No
Central Station
Monitored
Alarm Yes/No
Local Alarm
Yes/No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
BUILDING IMPROVEMENTS: Provide year updated
Wiring
Roof
Plumbing
HVAC
Other
Bldg. 1
Bldg. 2
Bldg. 3
INLAND MARINE & CRIME (Please include applicable ACORD Form)
Employee Tools $ _____________ Deductible $ ________________
Employee Dishonesty $ _____________ Deductible $ ________________
Forgery $ _____________ Deductible $ ________________
Money Securities (Inside & Outside) $ _____________ Deductible $ ________________
Other: $ _____________ Deductible $ ________________
NSP Garage Application 07.16 Page 7 of 8
FRAUD WARNINGS AND ATTESTATION
This application does not bind You or Us to complete the insurance, but it is agreed that the information contained herein shall be the
basis of the contract should a policy be issued.
FRAUD WARNING APPICABLE IN THE STATE OF NEW YORK
Any person who knowingly and with intent to defraud any insurance company or other person files an application for commercial
insurance or a statement of claim for any commercial or personal insurance benefits containing any materially false information, or
conceals for the purpose of misleading, information concerning any fact material thereto, and any person who, in connection with such
application or claim, knowingly makes or knowingly assists, abets, solicits or conspires with another to make a false report of the theft,
destruction, damage or conversion of any motor vehicle to a law enforcement agency, the department of motor vehicles or an
insurance company, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five
thousand dollars and the value of the subject motor vehicle or stated claim for each violation.
FRAUD WARNING
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim
containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a
fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
APPLICANT'S SIGNATURE: _______________________________________________________ DATE: _________________________
PRODUCER'S SIGNATURE: _______________________________________________________ DATE: _________________________
LICENSED AGENT: _____________________________________________________________ DATE: _________________________
(Applicable in Iowa only)
AGENT NAME: __________________________________________________ AGENT LICENSE NUMBER: _______________________
(Applicable to Florida Agents Only)
IMPORTANT NOTICE
As part of our underwriting procedure, a routine inquiry may be made to obtain applicable information concerning character, general
reputation, personal characteristics and mode of living. Upon written request, additional information as to the nature and scope of the
report, if one is made, will be provided.
FULLY COMPLETED AND SIGNED APPLICATION IS REQUIRED TO BIND COVERAGE. NO EXCEPTIONS!
NSP Garage Application 07.16 Page 8 of 8
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Used Car Dealer & Service Application (All Risks, Ltd)

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Completed 15 July 2020

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