Repair Shops

D. Ward Insurance Services, Inc since 1988 Office 770-974-0670


  Multiple Carries Will Compete
Our Agents know your business

 

  REPAIR SHOP APPLICATION

REPAIR SHOP INFORMATION
Full Legal Name of Business including any DBA Required
First Name Required
Last Name Required
What is your TITLE with the company or tell us what your Relationship is to the company? Required
Primary Phone Number Required
E-Mail Address Required
Mailing Address Required
City Required
State Required	AL GA NC SC TN
ZIP / Postal Code Required
Number of Years in Business under Legal Name Required
Business Type Required	Corporation Sole Proprietor Partnership LLC Other
If Corporation or LLC, Federal ID# Required or if Sole Proprietor SSN Required Required
Street Address of Repair Shop Required
City Required
State Required	AL GA NC SC TN
ZIP / Postal Code Required
Type of Garage Required	Auto Repair/Maintenance Shop Body Shop Combination Auto Repair & Body Shop
Is the Garage Operation located at a Home? Required	YES NO
Do You Own the Building? Required	Yes No
Approximate Age of Building Required
Type of Construction Required	Brick and Concrete BlockAll Concrete Block FrameFrame with Brick All MetalMetal with Frame All Other Construction
Approximate Sq. Footage of the garage-occupied area Required
What Type of Coverage Would You Like Quoted? Select All that Apply Optional	Garage LiabilityGaragekeepers Workers CompensationUmbrella for Higher Limits Shop ContentsShop Building Cyber LiabilityEmployment Practices Liability Insurance (EPLI)
How Many Bays are at your Shop? Required
Where are the Vehicles Stored After Hours? Required
What Type of Repair Work is Being Performed? Required
What Type of Vehicles are you Working On? Required
Any Major Engine Repairs? Required	Yes No
Any Frame Work Performed? Required	Yes No
Do you share your lot premises with another business? Required	Yes No
If yes, what business do you share your lot premises with? If no, type "NA." Required
Do you sell, rebuild, or repair autos with a salvage title? Required	I do not work with salvaged vehicles Yes, I work with salvaged vehicles
Do you perform mobile repair services? Required	Yes No
Do you have a tow truck? Required	Yes No
If you have a tow truck, do you tow for hire? Required	Yes, I tow for hire No, I only use the truck for my shop services NA, I don't have a truck
How Many Owners/Officers? Required
Any Inactive Officer(s) - List full name(s) or type "NA" Required
Number of Full-Time Clerical Employees or type "None" Required
Number of Part-Time Clerical Employees or type "None" Required
Number of Mechanic(s) or type "None" Required
Number of Non Employees 1099 or type "None" Required
Mechanic #1 Full Name as Appears on License Required
Mechanic #1 Date of Birth as Appears on License Required
Mechanic #1 License Number and State Required
Mechanic #1 Any violations, accidents or claims in 3 years Required	No known violation(s) for this mechanic Yes, this mechanic has violation(s)
Mechanic #2 Full Name as Appears on License or Type "NA" Required
Mechanic #2 Date of Birth as Appears on License or Type "NA" Required
Mechanic #2 License Number and State or type "NA" Required
Mechanic #2 Any violations, accidents or claims in 3 years or select "NA" Required	NA No known violation(s) for this mechanic Yes, this mechanic has violation(s)
Mechanic #3 Full Name as Appears on License or Type "NA" Required
Mechanic #3 Date of Birth as Appears on License or Type "NA" Required
Mechanic #3 License Number and State or type "NA" Required
Mechanic #3 Any violations, accidents or claims in 3 years or select "NA" Required	NA No known violation(s) for this mechanic Yes, this mechanic has violation(s)
Mechanic #4 Full Name as Appears on License or Type "NA" Required
Mechanic #4 Date of Birth as Appears on License or Type "NA" Required
Mechanic #4 License Number and State or type "NA" Required
Mechanic #4 Any violations, accidents or claims in 3 years or select "NA" Required	NA No known violation(s) for this mechanic Yes, this mechanic has violation(s)
Do you employ additional mechanics? If so, please send a list to dward@dwardins.com Required	No Yes
Do you sell vehicles or equipment? Required	Yes No
Do you allow customers to sell vehicles or equipment? Required	Yes No
Do you currently have a Garage Liability Policy? Required	Yes, my garage has insurance No
Name of current Insurance Company or type None Required
Has there been a lapse in coverage in the last 3 years? Required	No, there has not been a lapse in coverage. Yes, there has been a lapse in coverage.
Has the Repair Shop had any claims in the past 36 months Required	No claims in past 36 months Yes there are claim(s)
What Liability Limit of Insurance do you want quoted? Required	State Minimum to get started $300,000 $500,000 $1,000,000 Quote Umbrella
How did you hear about us? Please let us know Required	Internet SearchGa Indep Auto Dealer Assoc (GIADA) Mailing from D. WardE-Learning Concepts Dealer Training A FriendOther
If you selected "Other," tell us how you heard about us. Required
Is there anything else that you would like for us to know concerning your quote request? Optional
SIGNATURE REQUIRED
I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage.
By typing my name warrants my signature. Required
ADDITIONAL INFORMATION NEEDED
After you have sumitted your quote request, we will start working on your quote and we will help assist with obtaining your claim history. The insurance carriers require us to show prior proof of coverage along with claim history.
Thank you for your time and we will be in touch with you today unless this is after hours or on the weekend.
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