Insurance Quote Request for Pennsylvania Auto Repair Garage Insurance Program

Auto Repair Garage Program

General Repair Shops

Transmission Shops

Air Conditioning Shops

Auto Glass Shops

Auto Electric Shops

Business Name:
Contact Person:
Mailing Address:
City:	State: Zipcode:
Phone Number:	Fax:
E-Mail:
Federal ID #:	Business Organization:
Type of Operation:

Current Insurance Information:

Insurance Company: Expiration Date:

Number of Years in this Business Year of experience in same or related business: Full Time Employees (including yourself) Part Time Employees

Estimated Annual Sales/Receipts: Hours of Operation:

COVERAGES VALUE

Building:
$

Business Personal Property/Contents:
$

Property Deductible: $

Accounts Receivable Records (On Premises Limit):
$

Computer Equipment & Media:
$

Employee Dishonesty # of Employees:

Outdoor Signs:
$

Tenant's Exterior Glass:
Linear Feet

Valuable Papers & Records:
$

Liability Limit:

Garage Keepers Coverage (Coverage for customer's vehicles):
Comprehensive Deductible per Vehicle: $ 250 / $ 500

Building Information:

Contruction:
Year Built:
# of Stories:
Ground Floor Square Footage:

Building Updates (if premises is over 25 years old, give date and extent of renovation....

TYPE YEAR
DONE DESCRIPTION OF RENOVATION

Electrical

Heating

Plumbing

Roof

COVERAGES	VALUE
Building:	$
Business Personal Property/Contents:	$
Property Deductible:	$
Accounts Receivable Records (On Premises Limit):	$
Computer Equipment & Media:	$
Employee Dishonesty # of Employees:
Outdoor Signs:	$
Tenant's Exterior Glass:	Linear Feet
Valuable Papers & Records:	$
Liability Limit:
Garage Keepers Coverage (Coverage for customer's vehicles): Comprehensive Deductible per Vehicle: $ 250 / $ 500

Building Updates (if premises is over 25 years old, give date and extent of renovation....
TYPE	YEAR DONE	DESCRIPTION OF RENOVATION
Electrical
Heating
Plumbing
Roof

Quality of Building: Basement? Yes / No Central Air Conditioning? Yes / No

Interest of Insured: Percentage of building you occupy: %

For buildings with apartments:
Aparment Occupancy: Yes / No (If "yes", percentage of building: %) # of Apartment Units:
Second means of egress in apartments? Yes / No Emergency Lighting: Yes / No

Building Protection:
Central Alarm System: Local Only / Central System (monitored)

Sprinkler System? Yes / No If "Yes", % sprinklered

GENERAL QUESTIONS

Seasonal Operation? Yes / No

Is the insured busines part of a franchise?
If "Yes", Name of Franchisor: Yes / No

Is the insured business a member of a National Association that provides Auto Repair training and/or
certification? Yes / No

Does the business operate any business or own any property other than the described premises?
If "Yes", describe and provide insured carrier covering that operation: Yes / No

Are customers allowed in the shop area? Yes / No

Are signed work orders that clearly list the work to be done provided to customers prior
to the start of service or repairs? Yes / No

Are final inspections completed on vehicles before they are returned to customers? Yes / No

Any current cited violations for fire codes? Yes / No

Any current violations for Life Safety Codes? Yes / No

Are flammable liquids stored in approved safety containers? Yes / No

Is combustible waste placed in U.L. approved containers with lids? Yes / No

Antique, classic or high-valued vehicle specialists (other than incidental)? Yes / No

Auto body repair? Yes / No

Auto Club towing, 24 hour towing or thruway/muncipal towing contracts? Yes / No

Auto dismantling, rebuilding or restoration? Yes / No

Auto waxing or buffing? Yes / No

Is a car wash part of your operations? Yes / No

Is a convenience store part of your operation? Yes / No

Do you rent equipment or tools to others? Yes / No

Do you operate gas pumps? Yes / No

Do you install, repair or service sound systems or communications systems? Yes / No

Do you install, repair or service upholstery, tops or sunroofs? Yes / No

Are you an oil change & lubrication specialist (other than incidental)? Yes / No

Do you operate a marina as part of your operations? Yes / No

Do you perform any painting, detailing, or pinstriping? Yes / No

Do you operate a parking garage? Yes / No

Do you pickup or deliver customer's vehicles? Yes / No

Do you rent, lease or loan vehicles to others? Yes / No

Do you operate a restaurant or food service as part of your operations? Yes / No

Do you perform rustproofing, undercoating and/or glazing? Yes / No

Do you operate any salvage or wrecking operations or yards? Yes / No

Do you sell new or used vehicles? Yes / No

Any sales of tires for other than cars, or light and medium weight vehicles? Yes / No

Any sales of retreads? Yes / No

Any self-service or bay rentals? Yes / No

Service of antique, classic, custom or high-valued vehicles? Yes / No

Service or repair of farm or contractors equipment? Yes / No

Service or repair of mobile homes? Yes / No

Service or repair of motorcycles, ATVs or scooters? Yes / No

Service or repair of recreational vehicles? Yes / No

Service or repair of vehicles used in racing, stunt or speed demonstrations or events? Yes / No

Service or repair of vehicles over 20,000GVW? Yes / No

Any snow removal operations? Yes / No

Any tire recapping or vulcanizing operations? Yes / No

Truck Plaza operations Yes / No

Liquid propane gas sales that account for more than 5% of annual sales? Yes / No

Tire sales that account for more than 25% of annual receipts? Yes / No

Business activities other than auto repair that account for more than 25% of annual receipts?
Please explain....
Yes / No

GENERAL QUESTIONS
Seasonal Operation?	Yes / No
Is the insured busines part of a franchise? If "Yes", Name of Franchisor:	Yes / No
Is the insured business a member of a National Association that provides Auto Repair training and/or certification?	Yes / No
Does the business operate any business or own any property other than the described premises? If "Yes", describe and provide insured carrier covering that operation:	Yes / No
Are customers allowed in the shop area?	Yes / No
Are signed work orders that clearly list the work to be done provided to customers prior to the start of service or repairs?	Yes / No
Are final inspections completed on vehicles before they are returned to customers?	Yes / No
Any current cited violations for fire codes?	Yes / No
Any current violations for Life Safety Codes?	Yes / No
Are flammable liquids stored in approved safety containers?	Yes / No
Is combustible waste placed in U.L. approved containers with lids?	Yes / No
Antique, classic or high-valued vehicle specialists (other than incidental)?	Yes / No
Auto body repair?	Yes / No
Auto Club towing, 24 hour towing or thruway/muncipal towing contracts?	Yes / No
Auto dismantling, rebuilding or restoration?	Yes / No
Auto waxing or buffing?	Yes / No
Is a car wash part of your operations?	Yes / No
Is a convenience store part of your operation?	Yes / No
Do you rent equipment or tools to others?	Yes / No
Do you operate gas pumps?	Yes / No
Do you install, repair or service sound systems or communications systems?	Yes / No
Do you install, repair or service upholstery, tops or sunroofs?	Yes / No
Are you an oil change & lubrication specialist (other than incidental)?	Yes / No
Do you operate a marina as part of your operations?	Yes / No
Do you perform any painting, detailing, or pinstriping?	Yes / No
Do you operate a parking garage?	Yes / No
Do you pickup or deliver customer's vehicles?	Yes / No
Do you rent, lease or loan vehicles to others?	Yes / No
Do you operate a restaurant or food service as part of your operations?	Yes / No
Do you perform rustproofing, undercoating and/or glazing?	Yes / No
Do you operate any salvage or wrecking operations or yards?	Yes / No
Do you sell new or used vehicles?	Yes / No
Any sales of tires for other than cars, or light and medium weight vehicles?	Yes / No
Any sales of retreads?	Yes / No
Any self-service or bay rentals?	Yes / No
Service of antique, classic, custom or high-valued vehicles?	Yes / No
Service or repair of farm or contractors equipment?	Yes / No
Service or repair of mobile homes?	Yes / No
Service or repair of motorcycles, ATVs or scooters?	Yes / No
Service or repair of recreational vehicles?	Yes / No
Service or repair of vehicles used in racing, stunt or speed demonstrations or events?	Yes / No
Service or repair of vehicles over 20,000GVW?	Yes / No
Any snow removal operations?	Yes / No
Any tire recapping or vulcanizing operations?	Yes / No
Truck Plaza operations	Yes / No
Liquid propane gas sales that account for more than 5% of annual sales?	Yes / No
Tire sales that account for more than 25% of annual receipts?	Yes / No
Business activities other than auto repair that account for more than 25% of annual receipts? Please explain....	Yes / No

M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway     Murrysville, PA. 15668-1890
(724) 327-8474              (FAX) 327-7911
Toll Free: 1-800-977-2999       (FAX) 1-888-800-0034

Building Information:
Contruction:	Year Built:		# of Stories:	Ground Floor Square Footage: