Illinois
Tow Truck and/or Garage Insurance Quote

Underwriting Guidelines and Classes
.
Quote Urgency:  (Req'd)

Cell Color Key: Mandatory for All Quotes Tow Truck Risks Garage / Storage Risks
For RED Sections - this is common info for ALL QUOTES.
For BLUE Sections - this is info required for TOW TRUCK coverage.
For GREEN Sections - this is info required for GARAGE / STORAGE coverage.

Policyholder Info
Titleholder of Vehicle / Owner of Garage
Producing Agency
DBA (if applicable)
Contact Name
Producer Name
Garaging/Location Address
Contact Phone
Producer Phone
Garaging/Loc City
Garaging/Loc State
Garaging/Loc Zip
  Producer's E-mail or Fax (Req'd)
Mailing Address (if different from above)
Years in Business
 
Mailing City
Mailing State
Mailing Zip
Years in Industry
 
Proposed Effective Date
Ownership of Business
Nature of Business
Drivers
Dr# Name Date of Birth Sex State Driver's License # Violations or Accidents
(Last 3 years)
Describe in Comments Section
Driver
Exp
1
2
3
4
5
6
7
8
Additional Interests
UPDATED!!!! - There is a charge for some additional insured types.  If policy requires additional insureds, they must be entered below for quoted premium to be accurate.
Type Vehicle # Name Address
If you do not know the exact name and address, choose type and enter "TO FOLLOW" in the name and address section.  If more lines are required, note in Comments section.
Prior Insurance 
Does risk have prior insurance?     Yes     No
Carrier:     Policy #:     Premium:  
Eff Date:   Exp Date:   Renewal to your Office: Yes     No
Is current company non-renewing?     Yes     No
Prior Losses 
Has there been any losses in past 3 years?     Yes     No
Date of Loss
  
Description (including driver and amount paid)
Date of Loss
 
Description (including driver and amount paid)
Date of Loss
 
 
Description (including driver and amount paid)

Tow Truck Section
Vehicle Coverages 
Bodily Injury and Property Damage
Uninsured/Underinsured Motorist Bodily Injury
On Hook Coverage
On Hook Deductible
Vehicles 
1 Year
Vehicle Classification: (Req'd) (If physical is desired)
Make
Radius:
Current Value
Deductible
Model
VIN #
2 Year
Vehicle Classification
(If physical is desired)
Make
Radius
Current Value
Deductible
Model
VIN #
3 Year
Vehicle Classification
(If physical is desired)
Make
Radius
Current Value
Deductible
Model
VIN #
4 Year
Vehicle Classification
(If physical is desired)
Make
Radius
Current Value
Deductible
Model
VIN #
5 Year
Vehicle Classification
(If physical is desired)
Make
Radius
Current Value
Deductible
Model
VIN #
Tow Truck Underwriting Information
Does risk require a IL Commerce Commission Filing?     Yes     No
     If Yes, please complete the following:
          ICC Filing #:

          Does this application insure all commercial vehicles owned by applicant?    
Yes     No
               If No, Explain:

          Do you ever permit others to operate under your docket number?    
Yes     No
               If Yes, Explain:
Does risk have any repo or relocation operations?     Yes     No
     If Yes, please complete the following:
          Explain how risk handles a confrontation of an owner of a vehicle being repossessed?
         

          Does risk have any drive-away operations?     Yes     No
          If yes, please note number of plates in Comments section?  
Does risk have a storage lot or building?     Yes     No
     If Yes, in applicant's opinion, what is the condition of the storage lot / building?

     If Yes, does risk ever store vehicles for others, other than those used in the pursuit of your business?    
Yes     No
               If Yes, Explain:
Does risk have any vehicles' that have a GVW of over 45,000 lbs?     Yes     No
Does risk tow any vehicles that weight over 16,000 lbs?     Yes     No
Does risk engage in up righting, extracting, or towing of vehicles containing or leaking hazardous
     materials or substances?    
Yes     No
What percent of risk's operations snow plowing?      (Req'd) (If garage only select 0 - 5%)
Does risk  belong to a professional towing association?     Yes     No
Does risk "chase" or use any police scanners?     Yes     No
Are there any drivers under the age of 25 or over the age of 65?      Yes     No
     If Yes, how many drivers and what are their ages?
Does risk have ANY drivers that have physical/medical impairments including but not limited to alcoholism; diabetes; epilepsy; fainting spells; neurological disorders; seizures; heart/circulatory disorders or ANY mental/physical condition requiring continuous medication?      Yes     No
     If Yes, what is the condition and are they under doctor's care for this condition. Please give as much information as possible.
        
If risk is a storage lot and Garagekeeper's Legal Liability is desired, please complete section below!


Repair Shop / Storage Section
Complete the following ONLY if applicant owns a repair garage -OR- wants garage keepers legal on the storage lot
Garage Liability Coverages
Total Number of Owners/Employees    Select only if Repair Shop Operations.
Bodily Injury and Property Damage    Select only if Repair Shop Operations.
Uninsured/Underinsured Motorist Bodily Injury    Select only if Repair Shop Operations.
Medical Payments    Select only if Repair Shop Operations.
Garagekeeper's Legal      Available On Storage Lots Too!
Garagekeeper's Legal Deductible      Available On Storage Lots Too!
Do you need a City of Chicago Driveway Permit?    Available On Storage Lots Too!
Garage Underwriting Information  - Complete only if applicant owns repair garage
Is the risk a franchised or non-franchised auto dealer?     Yes     No
Does risk ever store vehicles for others, other than ones towed by you or cars you work on for your business? Yes     No
               If Yes, Explain:
Does risk lack a procedure in place to keep vehicle keys secured?     Yes     No
Does risk store any non-owned vehicles other than inside or within a fenced, lighted lot?     Yes     No
Does risk have any servicing pits?     Yes     No
Does risk sell, rent, or loan vehicles to anyone?     Yes     No
Does risk install trailer hitches or rent trailers?     Yes     No
Is risk a drive-away contractor?     Yes     No
     If yes, how many plates do they have?  
Is risk a relocator?     Yes     No
In applicant's opinion, what is the condition of the storage lot/building?
Does risk own, sell, sponsor or repair race cars?     Yes     No
Does risk customize or convert vehicles that alter performance?     Yes     No
Does risk deal in or repair emergency vehicles, ATV's or snowmobiles?     Yes     No
Does risk recap tires or sell recapped tires?     Yes     No
Does risk have a spray booth that is NOT UL approved?     Yes     No
Does risk involve frame straightening other than using a floor model?     Yes     No
Does risk buy or sell salvaged vehicles, repair vehicles with damages totaling more than 60% of vehicle's ACV, or
     dismantle or junk vehicles?    
Yes     No
Is risk in bankruptcy or legal reorganization?     Yes     No
Does risk use guard dogs, armed guards, or keep firearm on site to protect its premises?     Yes     No
Are there any drivers under the age of 25 or over the age of 65?      Yes     No
     If Yes, how many drivers and what are their ages?
Does risk have ANY drivers have physical/medical impairments including but not limited to alcoholism; diabetes; epilepsy; fainting spells; neurological disorders; seizures; heart/circulatory disorders or ANY mental/physical condition requiring continuous medication?     Yes     No
     If Yes, what is the condition and are they under doctor's care for this condition. Please give as much information as possible.
        

Comments
 
All quotations are subject to satisfactory Moving Violations Report and satisfactory Loss History.
(Company fee is fully earned at inception of policy.)

Applicant / Agent warrants that above are true to the best of his/her knowledge.
 If you wish to have a copy of this submission for your records, you must print page BEFORE submitting.






Please note - There might be a delay upon submission.
Do not exit until you receive the "Confirmation Page."
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