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Illinois Used Car Dealers Insurance Quote

Quote Urgency:  . Customer in Office Waiting ASAP Within 1 Hour Within 24 Hours Before Policy Expiration

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 . Individual Patnership Corporation LLC

Nature of Business Used Car Dealers

Garage Liability Coverages
Number of Dealer Plates	. 1 or 2 3 4 5 6 7 8 9 10 11 12
Bodily Injury and Property Damage	. $100/$300/$50 $350,000 CSL $500,000 CSL $750,000 CSL
Uninsured/Underinsured Motorist Bodily Injury	. $20,000/$40,000 $25,000/$50,000 $50,000/$100,000 $100,000/$300,000
Medical Payments	. No Coverage $1,000 $2,000 $5,000
Garagekeeper's Legal	. No Coverage $25,000 $50,000 $75,000 $100,000   Coverage For Non Owned Vehicles Only
Garagekeeper's Legal Deductible	. No Coverage $250 $500 $750 $1,000   No Dealers Open Lot Available
Do you need a City of Chicago Driveway Permit?	No Yes

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? . Excellent Good Fair Poor

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)	Driver Exp
1			. M F
2			. M F
3			. M F
4			. M F
5			. M F
6			. M F
7			. M F
8			. M F

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
. AI LP FC	. 1 2 3 4 5
. AI LP FC	. 1 2 3 4 5
. AI LP FC	. 1 2 3 4 5
. AI LP FC	. 1 2 3 4 5

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."