Carter & Company, L.L.P. 

 

 

 

GARAGE QUESTIONNAIRE

APPLICANT:
LOCATION: YRS IN BUS:

TOWN: COUNTY: TERR: STATE

DESCRIBE OPERATION:
EMP NAME POSITION FULL/PART
TIME		 D O B DRIVING RECORD FURNISHED AUTO
NUMBER OF: SERVICE VEHICLES WRECKERS DEALER TAGS

COVERAGES NEEDED ON SVC VEHICLE:

IF A CAR LOT, IS IT:           FENCED LIGHTED LOCKED
IF A BUILDING:           HEIGHT CONSTRUCTION BURG/FIRE ALARM  

COVERAGES

              LIMITS

LIABILITY

 (IF DRIVE-A-WAY INCLUDED, WHAT RADIUS )

MED PAY
PIP LIMITS (DEALERS ONLY)
UM/UIM LIMITS (DEALERS ONLY)

GKLL LIMITS

 DEDUCTIBLE: PER CAR , PER OCC
HOW MANY CUSTOMER'S CARS ON HAND ANY ONE TIME:

PHYS DAMAGE

 DEDUCTIBLE: PER CAR , PER OCC
NO. CARS ON LOT AT A.O.T:PER CAR VALUE

DRIVE-AWAY LIMTS

 DEDUCTIBLE RADIUS
CURRENT/PRIOR CARRIER:
THREE YEAR LOSS HISTORY:
REMARKS:

 

 

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