Auto Services - Hutch

Auto Services – Hutch

Business

Business name:

Legal entity:

Number of employees:

Contact name:

First Last

Phone:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other location(s):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email:

Website / Social Media:

Annual sales:

Annual payroll:

Federal tax ID number:

Franchise:

Current carrier:

Years with current carrier:

Policy expiration date:

Number of claims:

Claim(s) details:

Underwriting

Has the Applicant ever been canceled (incl. nonpay) or refused insurance of any kind by ERIE or any other insurance carrier?

If yes, please explain:

Has the Applicant filed for bankruptcy in the past 5 years?

If yes, please explain:

Property

Blanket

Deductible amount:

Coinsurance amount:

Replacement cost value:

Actual cash value:

Building value:

BPP / Contents:

Additional Property (signs, lights, clocks, fences, playgrounds, etc.)

Physical address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County:

Construction type:

Year built:

Year of roof:

Total square footage:

Your square footage:

List other tenants:

Sewer / Drain:

Money & Securities:

Tools off premises:

Computer Coverage:

Include enhancement endorsement

General Liability Limit

Select one:

Umbrella?

Rating basis:

Sales / Receipts:

Payroll:

Data Breach liability:

Employee benefit liability:

Employment practices liability:

Deductible:

Number of Employees (full-time):

Number of Employees (part-time):

Third-party coverage?

Premises Exposures

Smoke Alarms:

Fire Alarm:

Burglar Alarm:

Fire Extinguishers:

Sprinklered:

Outside Lighting:

Lot Protection:

Year of roof:

Roof type:

Roof concerns:

Peeling / Flaking paint?

If yes, where?

Any Deterioration / Dry Rot?

If yes, where?

Foundation condition:

Walking surfaces:

Heating type:

Heating condition:

Age:

Electrical condition:

Age:

Overall Housekeeping?

Garage Operations Exposures

What type of items do you repair?

(private passenger cars, heavy trucks, trailers, contractor’s equipment, atvs, boats, RVs, motorcycles, kit cars, racing vehicles, etc.)

Do you repair or service vehicles away from your premises?

Do you have any loaner cars available?

How many loaner cars do you have available?

What controls are in place before loan vehicle?

(drivers license, proof of insurance, written rental agreement, only certain customers)

Do you deliver or pickup customer vehicles?

Do you have a customer key drop off box?

Where are keys of overnight vehicles stored?

Do you sell used or recapped tires?

Do you do any contract towing?

(24-hour, AAA, state police, municipality, etc.)

Do you maintain a junkyard?

Do you own, sponsor, or work on race cars?

Do you provide an area for customers to wait while their vehicle is repaired?

Do you restrict the public from entering your garage work area?

Do you retain records on all repairs performed by your operation?

Are your mechanics certified?

Do you install airbags?

Do you disconnect airbag switches?

Please describe experience / certification

Is this risk part of a franchise?

(Franchised auto-services ops will receive a discount with ESB)

Auto Body Shop Exposures

Do you perform any painting operations?

Where?

(UL approved paint booth, homemade booth, open area of shop, outside)

Do you weld any parts together during repair?

Where are paints / solvents stored?

(UL approved cabinet, storage cabinet, paint mixing room)

Do you have a separate paint mixing room?

Construction type:

Workers’ Compensation

Expert modification factor:

Expert modification date:

Sole proprietor / Partners coverage?

Corporate officer coverage?

List

Class code #:

Payroll =

Average length of employment:

Safety:

(check all that apply)

Eye washing stations?

Autos

Auto used in business?

Autos titled to?

Hired / Non-owned?

Do your corporate officers maintain a personal auto policy?

If no, consider adding the corporate officers named coverage endorsement.

Included at direct primary

Limit is actual loss

Liability

Med Pay

Um / Uim

Comp

Coll

List

Year

Make

Model

VIN