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

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


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