All Risks, Ltd. – National Specialty Programs2555 Kingston Road, Suite 250 | York, PA 17402

Toll Free: 800-723-1022 | Phone: 717-600-0417 | Fax: 717-441-3784www.allrisks.com

Contact us at programs@allrisks.com

Garage Supplemental 10.16 Page 1 of 4

SUPPLEMENTAL GARAGE APPLICATIONPLEASE COMPLETE ONLY APPLICABLE SECTIONS

Auto wholesaler (Includes Auto Broker) is one who buys or sells used Autos to or from retail dealers or Auctions. Wholesalers do not sell directly to public.

Name of Applicant (include DBA):

Auctions ____ %Internet Sales % From a Sales Lot ____ % Phone Sales ____ %2. Do you sell autos to the public? If yes, explain: _____________________________________________________________

___________________________________________________________________________________________________

If no, describe method of delivery

8. If coverage for inventory is requested, where are the vehicles stored?

9. Who inspects vehicles to assure they are road worthy?

TIRE SALES/SERVICE INFORMATION

1. What percentage of your operations are tire sales? ____%

Type % New % Used Type % New % Used

Private Passenger Buses

Motorcycle/ATV Other Equipment

Heavy Trucks (over 30,000 GVW) Other, describe below

Other: ________________________________________________________________________________________

Please describe your quality assurance precautions to endure tires are properly installed and inflated:______________________________________________________________________________________________________________________________________________________________________________________________________

3. Are titles obtained when vehicles are purchased and transferred and when vehicles are sold? Yes No

6. Does your auto dealer customer arrange for pick up and delivery of autos you have purchased for them? Yes No

5. Do you have personal auto insurance? Yes No

4. Do you work out of your home? Yes No

7. Who do you sell vehicles to: Auctions Retail Dealers Other (Explain)

2.

3.

4.

Do you sell or service recaps or retreads? Yes No

If yes, explain: _______________________________________________________________________________________

Do you sell tires that were manufactured more than 5 years ago? Yes No

If yes, explain: _______________________________________________________________________________________

Do you service or sell vulcanized tires? Yes No

If yes, explain: _______________________________________________________________________________________

If yes, provide percent of sales to total tire sales: ___ %

Yes No5. Do you service or sell re-grooved or siped tires?If yes, provide percent of sales to total tire sales: ___ %

6. Do you repair or fix flat tires for heavy trucks? Yes No

If yes, do you use a safety cage when working with split rim or locking ring wheels? Yes No

7. Are you a mobile operation? Yes No

WHOLESALE DEALER INFORMATION

1. Please provide percentage from where the sale of autos takes place?

8. How do you dispose of old tires? ________________________________________________________________________

How often? ______________________

9. Where/how are old tires stored prior to disposal?__________________________________________________________

HEAVY TRUCK SECTION

If yes, details ________________________________________________________________________________________

Please describe your quality assurance precautions to endure tires are properly installed and inflated:

______________________________________________________________________________________________________________________________________________________________________________________________________

If yes, details ___________________________________________________________________________________________

If yes, what type? ________________________________________________________________________________________

_______________________________________________________________________________________________________

8. Locations where you conduct operations:

__ At your premises ___ %

__ At customer’s premises ___ %

__ Roadside ___ %

MOTORCYCLE SALES/REPAIR SECTION

1. Types of Units Being Sold/Repaired

Motorcycles ___ % Go Karts ___ % Jet Skis/Watercraft ___ %

ATV’s/UTV’s ___ % Dirt Bikes ___ % Mopeds/Scooters ___ %

Trikes ___ % Other % Describe: ______________________________________ ____________________________________

Garage Supplemental 10.16 Page 2 of 4

If not, describe how units are protected: _______________________________________________________________

1. Is any Fifth Wheel Installation/Repair work done? Yes No

2. Is any framework done? Yes No

Any cutting or stretching? Yes No

Is a machine used? Yes No

3. Do you repair or fix flat tires for heavy trucks? Yes No

If yes, do you use a safety cage when working with split rim or locking ring wheels? Yes No

4. Is work done on tanker trailers? Yes No

5. Is there trailer repair to box or cargo trailers? Yes No

6. Is there transmission work (including clutch and differential work? Yes No

7. Is there welding work? Yes No

9. Do you pick up or deliver customer autos? Yes No

11. Do all drivers have a CDL? Yes No

10. Does the owner have a CDL (Commercial Drivers License)? Yes No

2. Are inventory and customer units stored inside? Yes No

Yes

If yes, what percentage? ____%

Provide details of work done ___________________________________________________________________________

If yes, provide details _________________________________________________________________________________

___________________________________________________________________________________________________

If yes, provide details _________________________________________________________________________________

___________________________________________________________________________________________________

Gross Receipts from uninstalled parts/accessories sales $____________

RECREATIONAL VEHICLE SALES/SERVICE SECTION

If yes, now many vehicles are stored at any one time _________

A copy of the agreement must be submitted for review. It should require the customer to maintain insurance.

Garage Supplemental 10.16 Page 3 of 4

Gross Receipts from uninstalled parts/accessories sales $____________

Yes No

No

3. Do you permit off premises customer test drives?If yes, are they: Accompanied Unaccompanied

Is proof of motorcycle license and auto insurance checked prior to all test drives?

4. Do you perform any customization or fabrication? Yes NoIf yes, what percentage? ____ %

Provide details of work done __________________________________________________________________________

5. Do you perform structural alterations (Fork or Frame)? Yes NoIf yes, what percentage? ____ %

Provide details of work done __________________________________________________________________________

6. Do you convert bikes to trikes or do any Kit Assembly? Yes NoIf yes, what percentage? ____ %

Provide details of work done and manufacturer of kits if any:__________________________________________________

7. Do you manufacture bikes or bike parts? Yes No

8. Do you alter the original performance of manufacturer specifications? Yes No

9. Are any accessories or parts sold but not installed? Yes No

10. Do you sponsor events (rallies, rides, shows, etc.)? Yes

11. Do you lease, loan or rent any units? Yes

12. Do you conduct any driver training or education classes? Yes

13. Are any units furnished for personal use? Yes

1. Do you rent RV’s to others? Yes

2. Do you rent RV storage space to others? Yes

Is a written storage agreement used? Yes

Yes

No

No

No

No

No

No

No

No 3. Do you do any Liquefied Petroleum (LPG) filling?(Exchange only is acceptable with proper storage of tanks)

4. Do you install or repair appliances or heating systems? Yes No

If yes, what are employee qualifications? _________________________________________________________________

5. Do you sell uninstalled parts/accessories? Yes No

Garage Supplemental 10.16 Page 4 of 4

FINANCING PROCEDURES:

3. Name and title of staff member arranging financing:

4. Experience of staff member arranging financing:

VERIFICATION PROCEDURES USED FOR ODOMETER/DAMAGE DISCLOSURE:

Carfax or similar industry report on all autos

Title search on all autos

Vehicle inspection on all vehicles by:In-house mechanic

Independently insured mechanic (Certificate of Insurance must be on file)

Describe procedures if prior damage or salvage title is discovered:

DISCLOSURE PREOCEDURES USED

AUTO TITLING

1. Staff member responsible for DMV paperwork:

2. Experience of staff member:

3. Describe procedure for verification that titles and liens are filed accurately:

APPLICANT'S SIGNATURE: DATE:

PRODUCER'S SIGNATURE: DATE:

LICENSED AGENT: DATE:(Applicable in Iowa only)

AGENT NAME: AGENT LICENSE NUMBER:(Applicable in Florida Agents only)

1. Do you follow Federal, State and Local Truth-in-Lending statutes? Yes No

2. Is the auto’s title transferred into the customer’s name at time of possession? Yes No

In-House Percent of sales ____________%

Dealer Arranges Financing with Outside Firm Percent of sales ____________%

5. Do you have in-house approval authority? Yes No

7. Do you require final approval prior to releasing the auto? Yes No

6. Do you follow Federal, State and Local Truth-in-Lending statues? Yes No

Customer Arranges Own Financing Percent of sales ____________%

Checklist

Customer written acknowledgement

Other:

ERRORS OR OMMISSIONS