Illinois
Used Car Dealers Insurance Quote

Underwriting Guidelines Classes
Quote Urgency: 
Applicant/Producer Info
Name of Applicant
Producing Agency
DBA
Contact Name
Producer Name
Location Address
Contact Phone
Producer Phone
Location City
Location State
Location Zip
  Producer's Producer # (if appl)
Mailing Address (if different from above)
Years in Business
Producer's E-mail or Fax (Req'd)
Mailing City
Mailing State
Mailing Zip
Years in Industry
 
Proposed Effective Date
Ownership of Business
Nature of Business

Garage Liability Coverages
Number of Dealer Plates
Bodily Injury and Property Damage
Uninsured/Underinsured Motorist Bodily Injury
Medical Payments
Garagekeeper's Legal   Coverage For Non Owned Vehicles Only
Garagekeeper's Legal Deductible   No Dealers Open Lot Available
Do you need a City of Chicago Driveway Permit?

Garage Underwriting Information
1) Is the risk an auto dealer?     Yes     No
2) Used for public livery? Yes     No
3) Does risk lack a procedure in place to keep vehicle keys secured?     Yes     No
4) Does risk store any non-owned vehicles other than inside or within a fenced, lighted lot?     Yes     No
5) Does risk have any servicing pits?     Yes     No     N/A
6) Does risk rent, or loan vehicles to anyone?     Yes     No
7) Does risk install trailer hitches or rent trailers?     Yes     No
8) Is risk a drive-away contractor?     Yes     No
9) Is risk a relocator?     Yes     No
10) In applicant's opinion, what is the condition of the lot/building?
11) Does risk have a spray booth that is NOT UL approved?     Yes     No     N/A
12) Does risk use guard dogs, armed guards, or keep firearm on site to protect its premises?     Yes     No
13) Are there any drivers under the age of 25 or over 70?      Yes     No (Req'd)
     If Yes, how many drivers and what are their ages?
14) 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


All Owners, Employees and 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

Prior Insurance / Losses 
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
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)


Additional Interests 
Type Vehicle # Name Address


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.


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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