Auto Repair & Service Liability
Owner Info
First Name
Last Name
Address
City
Zip
State
Select State
AL
AZ
AR
FL
GA
ID
IA
IL
IN
KS
KY
LA
MD
MI
MN
MS
MO
NC
NE
NJ
NM
OH
OK
OR
PA
SC
TN
TX
UT
VA
WA
WI
WY
Phone Number
Email
Property Info
Address
City
Zip
State
Select State
AL
AZ
AR
FL
GA
ID
IA
IL
IN
KS
KY
LA
MD
MI
MN
MS
MO
NC
NE
NJ
NM
OH
OK
OR
PA
SC
TN
TX
UT
VA
WA
WI
WY
Requested Effective Date
Business Description
Liability Limits
Please Select
10,000
20,000
30,000
40,000
50,000
GarageKeepers Per Event Limit Requested
Please Select
10,000
20,000
30,000
40,000
50,000
GarageKeepers Deductible Requested
Please Select
10,000
20,000
30,000
40,000
50,000
Limit per auto (For All Location)
Please Select
50,000
100,000
150,000
200,000
250,000
Building Value
BPP Value
BI Value
Sign Value
Building Constructions
Please Select
Yes
No
Building Condition
Select
Average
Old
New
Year Built
Building Area in SQFT
Roof Year Built/Replaced
Please Select
1 Year
2 Year
3 Year
4 Year
5 Year
6 Year
7 Year
8 Year
9 Year
10 Year
BI Option
Select
Yes
No
BI Extra Expense
Select
Yes
No
Central Station Alarm
Please Select
Yes
No
Sprinklered
Select
Yes
No
IS the risk a, new purchase
Select
Yes
No
Years since All major system (heating,plumbing,air condition,electrical) have been updated)
Private Passenger Cars
SUV's, Light Trucks
Antique/Classic Cars
High Performance Cars
Trucks with GVW 10-25,000#
Trucks with GVW 25,000# or Greater
Farm or Construction Equipment
Mobile Homes
Applicant Performs Other Repairs?
Describe Other Repairs
Truck - Tractors
Motorcycles, Dirt Bikes, or ATV's
Boats, Jet Skis, or other Watercraft
Buses
Emergency Vehicles (Fire, Ambulance, Police, Etc.)
RV's, Motor Homes, Travel Trailers
Snowmobiles
Trailers (Non-recreational)
Submit
