Submit Auto Dealers Risk

Agent Information

Agent Name

Agency Name

Email

Phone

Insured Information

Insured Name

DBA (if applicable)

Contact Name

Contact Email

Contact Phone

Business Website

Years in Business

FEIN/Tax ID

Mailing Address

City

State

ZIP Code

Business Information

Type of Dealership

Annual Revenue ($)

Number of Employees

Number of Sales Personnel

Number of Mechanics

Hours of Operation

Inventory Information

Average Inventory Value ($)

Maximum Inventory Value ($)

Average Number of Vehicles on Lot

Maximum Value of Any One Vehicle ($)

Percentage of Exotic/High Value Vehicles (%)

Do you sell vehicles on consignment?

Property Information

Property Address

Lot Size (acres)

Building Size (sq ft)

Year Built

Construction Type

Number of Service Bays

Lot Security (check all that apply)

Fence

Gate

Lighting

Cameras

Security Guard

Alarm System

Key Control Procedures

Operations Information

Services Provided (check all that apply)

Vehicle Sales

Repair Services

Body Work

Painting

Detailing

Parts Sales

Loaner Vehicles

Other

If Other, please specify:

Test Drive Procedures

Number of Dealer Plates

Coverage Information

Requested Effective Date

Expiration Date

Dealer Open Lot Limit ($)

Deductible ($)

Garage Liability Limit

Garagekeepers Limit

Building Value ($)

Contents Value ($)

Business Income ($)

Tools & Equipment Value ($)

Document Upload

Upload Loss Runs

Drag and drop your loss runs here or click to browse

Upload ACORD Forms

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Upload Property Photos

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