1. Applicant & Business Information Requested Policy Effective Date (Required) Business Entity Type (Required) Primary Dealership / Physical Address (Required) Pre-filled from your initial quote request. Please review and correct if needed.
Is your mailing address the same as the physical dealership address? (Required) Select No only if mail should be sent to a different address.
Mailing Address (Required) Primary / Inspection Contact (Required)
First
Last
If less than 3 years in business or no prior insurance, explain prior relevant experience, training, or certifications.
Description of Operations (Required)
Do you perform service or repair work on non-owned/customer vehicles? (Required) Pre-filled from your initial quote request. Please confirm the answer is still correct.
What types of vehicles do you sell or hold for sale? (Required) Select vehicle types that are part of your dealership sales/inventory. Do not select a type merely because you repair or service it.
What other dealership operations do you perform? (Required) These are separate from the types of vehicles you sell.
Have all drivers had a valid U.S. driver's license for at least 2 years? (Required) Do you use contract or occasional drivers not listed below? (Required)
Person 1 Person 1 – Date of Birth (Required) Person 1 – Does this person hold a Commercial Driver's License (CDL)? (Required) A CDL is a commercial driver's license; this is separate from the regular driver's license number above.
Person 1 – How does this person use dealership vehicles? (Required) Choose the option that best describes this person's access to or use of vehicles owned by or held for sale by the dealership.
Person 1 – Personal Auto Policy in Place? (Required) Person 1 – Any accidents or moving violations in the past 3 years? (Required) Select Yes only if this person has had an accident or moving violation within the past 3 years.
Person 1 – Accident / violation details
Shown only when Yes is selected above.
Person 1 – Full or Part Time (Required) Person 1 – Status / Role (Required)
Person 2 Person 2 – Date of Birth Person 2 – Does this person hold a Commercial Driver's License (CDL)? (Required) A CDL is a commercial driver's license; this is separate from the regular driver's license number above.
Person 2 – How does this person use dealership vehicles? (Required) Choose the option that best describes this person's access to or use of vehicles owned by or held for sale by the dealership.
Person 2 – Personal Auto Policy in Place? (Required) Person 2 – Any accidents or moving violations in the past 3 years? (Required) Select Yes only if this person has had an accident or moving violation within the past 3 years.
Person 2 – Accident / violation details
Shown only when Yes is selected above.
Person 2 – Full or Part Time (Required) Person 2 – Status / Role (Required)
Person 3 Person 3 – Date of Birth (Required) Person 3 – Does this person hold a Commercial Driver's License (CDL)? (Required) A CDL is a commercial driver's license; this is separate from the regular driver's license number above.
Person 3 – How does this person use dealership vehicles? (Required) Choose the option that best describes this person's access to or use of vehicles owned by or held for sale by the dealership.
Person 3 – Personal Auto Policy in Place? (Required) Person 3 – Any accidents or moving violations in the past 3 years? (Required) Select Yes only if this person has had an accident or moving violation within the past 3 years.
Person 3 – Accident / violation details
Shown only when Yes is selected above.
Person 3 – Full or Part Time (Required) Person 3 – Status / Role (Required)
Person 4 Person 4 – Date of Birth (Required) Person 4 – Does this person hold a Commercial Driver's License (CDL)? (Required) A CDL is a commercial driver's license; this is separate from the regular driver's license number above.
Person 4 – How does this person use dealership vehicles? (Required) Choose the option that best describes this person's access to or use of vehicles owned by or held for sale by the dealership.
Person 4 – Personal Auto Policy in Place? (Required) Person 4 – Any accidents or moving violations in the past 3 years? Select Yes only if this person has had an accident or moving violation within the past 3 years.
Person 4 – Accident / violation details
Shown only when Yes is selected above.
Person 4 – Full or Part Time (Required) Person 4 – Status / Role (Required)
Person 5 Person 5 – Date of Birth (Required) Person 5 – Does this person hold a Commercial Driver's License (CDL)? (Required) A CDL is a commercial driver's license; this is separate from the regular driver's license number above.
Person 5 – How does this person use dealership vehicles? (Required) Choose the option that best describes this person's access to or use of vehicles owned by or held for sale by the dealership.
Person 5 – Personal Auto Policy in Place? (Required) Person 5 – Any accidents or moving violations in the past 3 years? Select Yes only if this person has had an accident or moving violation within the past 3 years.
Person 5 – Accident / violation details
Shown only when Yes is selected above.
Person 5 – Full or Part Time (Required) Person 5 – Status / Role (Required)
Person 6 Person 6 – Date of Birth (Required) Person 6 – Does this person hold a Commercial Driver's License (CDL)? (Required) A CDL is a commercial driver's license; this is separate from the regular driver's license number above.
Person 6 – How does this person use dealership vehicles? (Required) Choose the option that best describes this person's access to or use of vehicles owned by or held for sale by the dealership.
Person 6 – Personal Auto Policy in Place? (Required) Person 6 – Any accidents or moving violations in the past 3 years? Select Yes only if this person has had an accident or moving violation within the past 3 years.
Person 6 – Accident / violation details
Shown only when Yes is selected above.
Person 6 – Full or Part Time (Required) Person 6 – Status / Role (Required) Are any specifically scheduled autos requested on this policy? (Required) How many specifically scheduled company autos need to be listed? (Required) If scheduled autos are requested, have all members of the owner's household been disclosed? If scheduled autos are requested, have all regular and infrequent drivers (including children away at school) been disclosed? If No to either household/driver disclosure question, provide names, ages, and driving information.
4. Locations, Prior Insurance & General Operations Insurance history status (Required) Choose the option that best describes the dealership's current insurance status.
Why did your prior dealer insurance end? (Required) Date Prior Coverage Ended Shown only when you indicate that prior coverage ended.
Why did the policy lapse?
Briefly explain why coverage expired or lapsed.
Please explain the other reason the prior policy ended.
What reason did the carrier give for non-renewing the policy?
Enter the carrier's reason, if known.
What reason did the carrier give for cancelling the policy?
Enter the carrier's reason, if known.
Current Policy Expiration Date Any losses / claims in the last 36 months? (Required) Loss details – date, amount, and description for each loss
In the past 3 years, has this type of insurance been cancelled, declined, or non-renewed? (Required) If Yes, explain why it was cancelled, declined, or non-renewed.
Include the reason provided by the insurance company, if known.
Do any owners have an ownership interest in or operate any other business? (Required) If Yes, provide legal name, entity type, address, operations, relationship, whether employees are shared, and whether liability insurance is carried elsewhere.
Do you rent any space at this location to others? (Required) If Yes, describe the occupancy
Do renters carry their own insurance? Are vehicles loaned to customers? (Required) Is there a written contract agreement for loaned vehicles? Do you obtain a copy of the customer's driver's license? Do you verify that the customer has auto insurance? Are firearms kept on the premises? (Required) Do you conduct towing operations? (Required) If Yes, do you tow for hire? Do you have Transporter or Repairer Plates (not Dealer plates)? (Required) How are Transporter / Repairer Plates used?
Do you lease, rent, or loan Dealer, Transporter, or other plates? (Required) Do you lease or rent vehicles? (Required) Are leasing/rental operations covered elsewhere? If covered elsewhere, provide carrier, policy number, and policy dates.
Related / incidental operations (select all that apply) (Required) For each related operation selected, provide the applicable payroll, gross receipts, gallons, square footage, acres, or other rating basis and a brief description.
Location 1 – Lot Security (Required) Select all security measures used at this location.
Location 1 – Are security cameras centrally monitored 24/7? Location 2 – Lot Security Select all security measures used at this location.
Location 2 – Are security cameras centrally monitored 24/7? Location 3 – Lot Security Select all security measures used at this location.
Location 3 – Are security cameras centrally monitored 24/7? Location 4 – Lot Security Select all security measures used at this location.
Location 4 – Are security cameras centrally monitored 24/7? Do you ever store or display owned or non-owned autos at a different location? (Required) If Yes, provide location details, how often used, and approximate values stored/displayed there.
How are keys secured during business hours? (select all that apply) (Required) How are keys secured when the lot or shop is closed? (select all that apply) (Required) If a vehicle-mounted lockbox is used, are keys/devices removed from vehicles and stored inside after hours? Do you park customers' vehicles on the street? (Required) Do you have an owned vehicle racing or exhibition exposure? (Required) If Yes, is the vehicle titled to the Named Insured? Do you service vehicles involved in racing or exhibition events? (Required) If Yes, provide percentage, work performed, and location.
Do you sponsor any racing-related activities? (Required)
5. Dealer Sales Operations Do you have a dealer's license? (Required) Do you import vehicles from or export vehicles to countries outside the United States? (Required) This refers to international import/export, not vehicles purchased or sold in another U.S. state.
If Yes, describe import/export operations.
If exporting, are titles transferred before vehicles leave your premises? Do you operate an auction? (Required) Is this a pawn shop with Auto Pawn operations? (Required) Do you always take possession of the vehicle? Are autos the only items pawned? Are there any Title Pawn operations? Do you have, or have you applied for, dealer plates? (Required) Who drives or transports newly acquired vehicles to your lot? (Required) If using transporters, do you obtain certificates of insurance? Are newly acquired autos driven/transported over 300 road miles from point of purchase to your lot? (Required) Do you deliver vehicles to customers after the sale is complete? (Required) Who drives delivered vehicles? Confirm: Do you sell salvage or total-loss titled vehicles? (Required) This answer will be carried forward from your initial quote request. Please confirm it is still correct.
If Yes, do you repair salvage titled vehicles before sale? Are titles transferred promptly upon sale in compliance with state guidelines? (Required) Confirm: Do you offer Buy Here / Pay Here (BHPH)? (Required) This answer will be carried forward from your initial quote request. Please confirm it is still correct.
If Yes, do you transfer title to the buyer at sale and remain lienholder? Do you repossess vehicles you sell yourself? Do customers test drive vehicles? (Required) Do you always ride along on test drives? Do you verify the customer has a current driver's license in hand before test drives? Do you allow overnight or extended test drives? Do you use any owned autos for a rideshare program (e.g., Uber/Lyft)? (Required) Select all service / repair work performed For each service type selected, provide the approximate percentage of total service work. Percentages should total 100%.
Do you outsource or subcontract any work? If Yes, are certificates of insurance obtained? Describe subcontracted work.
Are signs posted to keep customers out of the work area? Do you sell gasoline? Gasoline sales type Do you sell Liquefied Petroleum Gas (LPG)? LPG sales type Is the LPG storage tank protected by collision barriers? Are No Smoking signs posted? Do only qualified operators fill customers' tanks? Do you install, service, or repair Advanced Driver Assistance Systems (ADAS)? Do the systems allow self-driving but require intervention in severe conditions? Do the systems perform all driving tasks under all conditions with no human attention? Do you install lift kits? Do you lift vehicles over 6"? Describe training and experience with lift kits.
Do you perform paint work? Do you have a spray paint booth / separate room? Is the spray booth / room well ventilated? Are all flammable materials kept in a fire-proof metal cabinet when not in use? Do you perform performance enhancement work? Are vehicles street legal when your work is completed? Describe performance enhancement work.
If you operate a parking lot/structure/carousel, do you provide charging stations to customers? Do you drive customers' vehicles for pickup and/or delivery? Do you sell, install, or service tires? Do you sell/install/service racing tires? Do you sell/install/service recap or retread tires? Do you perform quality control for proper installation, lug torque, and tire sizing? Do you sell new tires manufactured more than 3 years ago? When selling less than a full set, are the newest tires always installed on the rear axle? Do you sell used tires over 4 years old or with less than 4/32 usable tread? If you sell used tires, how are they marked / identified?
Tire service work performed Coverage areas you would like us to evaluate Select any areas you want us to evaluate. If you are unsure, choose “Other / Please Recommend.” Brief descriptions are for general guidance only; actual coverage depends on carrier terms, conditions, limits, and exclusions.
Do you ever have vehicles at your dealership that you do not own? (Required) This includes customer vehicles, consignment vehicles, or other non-owned vehicles.
What types of non-owned vehicles do you have? (Required) Describe other non-owned vehicles
Do you want coverage for vehicles owned by the dealership / held for sale? (Required) Inventory interests to be covered Loss Payee / Floor Plan Company – name and address
Any Additional Insured requested? Provide name, address, and relationship.
Do you hire, rent, lease, or borrow vehicles for business use that are not owned by the dealership? (Required) Do any owners, officers, or employees need Drive Other Car coverage for vehicles they do not own? (Required) Are all scheduled units registered and titled in the business name? If No, explain ownership / title.
Are any scheduled units operated using a Dealer or Transporter Plate?
Scheduled Auto 1 Auto 1 – Vehicle Usage Auto 1 – Loss Payee / Lessor name and address (if any)
Scheduled Auto 2 Auto 2 – Vehicle Usage Auto 2 – Loss Payee / Lessor name and address (if any)
Scheduled Auto 3 Auto 3 – Vehicle Usage Auto 3 – Loss Payee / Lessor name and address (if any)
Scheduled Auto 4 Auto 4 – Vehicle Usage Auto 4 – Loss Payee / Lessor name and address (if any)
Scheduled Auto 5 Auto 5 – Vehicle Usage Auto 5 – Loss Payee / Lessor name and address (if any)
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