Garage Liability Application GARAGE LIABILITY QUESTIONNAIRE Name of Business Contact Person Business Entity Individual Partnership Joint venture Corporation Other Phone Number E-mail Address Location Address City State ZIP Code Types of Autos Sold Private Passenger Small Trucks SUVs Vans Other Current Insurance Carrier Premium Exp Date Years in Business If New, experience No Prior Insurance No Prior Losses Radius of Pick Up and Delivery From Lot 0-300 Miles 301-500 Miles 501-1000 Miles Unlimited How Are Autos Stored Standard Lot Inside Building Lot is Open Other Type of Lot Total Number of Plates Are Tags Used For Business Only Personal Both Coverages and Limits of Liability Limit of Liability PIP if Available Medical Payments Uninsured Motorist Dealer’s Open Lot: Comprehensive Specified Causes Collision Total Lot Limit Maximum Value Per Single Auto Avg. Number of Cars on Lot Garage Keepers Dealer Operations EMPLOYEE AND NON-EMPLOYEE INFORMATION – LIST ALL OWNERS, EMPLOYEES, DRIVERS & HOUSEHOLD MEMBER Location Name Driver-License & ST Date of Birth Violations & Accidents Within Past 3 yrs. Status (A,B,C,D)See Below For Codes(1) Hours Worked FT/PT Auto Usage (2) (F,B,N) (1)Status Codes: A.) Regular Operator: owners, partners, officers, salespersons, managers & employees with regular operation. B.) Other Employee: clerical staff, lot personnel, mechanics & those who do not regularly operate a vehicle. C.) Non-employee: inactive owners, partners, officers and their spouses. D.) Contract Driver: scheduled individual (provide name) or blanket. (2)Usage: F) Furnished B) Business Use N) None Submit Home About Us Dealer Bond States Submit Payment Garage Liability Insurance Contact Us FAQ Blog Copyright © 2017 Absolute Surety, LLC — Lyrical WordPress theme by GoDaddy
