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Home > Business > Repair Shops

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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

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

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

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

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.

ENTER VALIDATION CODE

For Security of your personal information, enter code and press submit

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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Mailing: 1720 Mars Hill Rd #8-185, Acworth, GA 30101
Physical: 3440 Blue Springs Road, #503j, Kennesaw, GA 30144
P: (770) 974-0670 | F: (770) 974-8577 |
E: dward@dwardins.com

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