/ Yes Yes Yes No No No / Yes Yes Yes No No No / Yes Yes Yes No No No / Yes Yes Yes No No No / Yes Yes Yes No No No / Yes Yes Yes No No No / Yes Yes Yes No No No Do you utilize unscheduled (contract) drivers? Yes No If yes: 1. Do you verify each has a license? Yes No valid US driver’s 2. How many times per month? Mechanic *Status: 6 1 Active Owner, Partner or Officer 7 Clerical 2 Inactive Owner, Partner or Officer 8 Scheduled Driver 3 Salesperson 9 Spouse of Owner, Partner or Officer 4 Manager 10 Child of Owner, Partner or Officer (whether licensed to drive or not) 5 Lot Person 11 Other: **Hours Worked: F Full Time (over 20 hours per week) P Part Time (20 hours or less per week) N Non-Employee Have all individuals with access to use a covered auto been listed on this application Yes No If no, explain: 7. COVERAGE REQUESTED Provide limits and deductibles for all requested coverages: COVERAGE LIMITS DEDUCTIBLES Each Accident Aggregate $ PD (Auto & Other Than Auto) (Other Than Auto only) Garage Liability $ BI & PD $ 1x 2x 3x Personal Injury Protection $ $ Uninsured Motorists $ Underinsured Motorists $ Medical Payments Auto & Premises $ Premises Only Errors & Omissions Odometer Truth in Lending Title Garagekeepers Legal Direct Excess Direct Primary Fire/Theft Per Location Per Auto Specified Causes Loc 1 $ Comprehensive $ $ Loc 2 $ Loc 3 $ Dealers Physical Damage Per Location Per Auto Fire/Theft Loc 1 $ $ $ Specified Causes Loc 2 $
/ Yes No Yes No Yes No / Yes No Yes No Yes No / Yes No Yes No Yes No / Yes No Yes No Yes No / Yes No Yes No Yes No / Yes No Yes No Yes No / Yes No Yes No Yes No Do you utilize unscheduled (contract) drivers? Yes No If yes: 1. Do you verify each has a valid US driver’s license? Yes No 2. How many times per month? *Status: 6 Mechanic 1 Active Owner, Partner or Officer 7 Clerical 2 Inactive Owner, Partner or Officer 8 Scheduled Driver 3 Salesperson 9 Spouse of Owner, Partner or Officer 4 Manager 10 Child of Owner, Partner or Officer (whether licensed to drive or not) 5 Lot Person 11 Other: **Hours Worked: F Full Time (over 20 hours per week) P Part Time (20 hours or less per week) N Non-Employee Have all individuals with access to use a covered auto been listed on this application Yes No If no, explain: 7. COVERAGE REQUESTED Provide limits and deductibles for all requested coverages: COVERAGE LIMITS DEDUCTIBLES Garage Liability Each Accident (Auto & Other Than Auto) Aggregate (Other Than Auto only) $ PD $ BI & PD $ 1x 2x 3x Personal Injury Protection $ $ Uninsured Motorists Underinsured Motorists $ $ Medical Payments Auto & Premises Premises Only $ Errors & Omissions Odometer Truth in Lending Title Garagekeepers Fire/Theft Specified Causes Comprehensive Legal Direct Excess Direct Primary Per Location Per Auto Loc 1 $ $ $ Loc 2 $ Loc 3 $ Dealers Physical Damage Fire/Theft Specified Causes Per Location Per Auto Loc 1 $ $ $ Loc 2 $
IAT-GarageApplication-ALL.docx