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! |
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.
|