138 Garage and Dealers Application
Applicant (first named insured)
*
Coverages/Limits
Select YES or NO for each
Coverages: Liability
Any auto
Select
Yes
No
All owned autos
Select
Yes
No
Owned private passenger autos only
Select
Yes
No
Owned autos other than private passenger
Select
Yes
No
Specifically described autos
Select
Yes
No
Hired autos only
Select
Yes
No
Non-owned autos in garage business
Select
Yes
No
Limits of liability: Garage operations
Each accident: auto only($)
*
Each accident: other than auto only ($)
*
Aggregate: auto only
*
Aggregate: other than auto only
*
Limits of liability: Dealers
Select
Limited
Unlimited
Coverages: Personal injury protection
Owned autos subject to no-fault
Select
Yes
No
Specifically described auto parts
Select
Yes
No
Limits of personal injury protection
Amount per person ($)
Waiver of P.I.P.?
Select
Yes
No
Coverages: Additional personal injury protection
Owned autos subject to no-fault
Select
Yes
No
Specifically described auto parts
Select
Yes
No
Limits of additional personal injury protection
Limit ($)
Coverages: Medical payments
Any auto
Select
Yes
No
All owned autos
Select
Yes
No
Owned private pass autos only
Select
Yes
No
Owned autos other than private pass
Select
Yes
No
Specifically described autos
Select
Yes
No
Hired autos only
Select
Yes
No
Non-owned autos in garage business
Select
Yes
No
Limits of medical payments
Limit ($)
Type of limit
Select
Automobile
Premium operations
Coverages: Uninsured motorist
All owned autos
Select
Yes
No
Owned private passenger autos only
Select
Yes
No
Owned autos other than private passenger
Select
Yes
No
Owned autos subject to UM law
Select
Yes
No
Specifically described autos
Select
Yes
No
Limits of uninsured motorist
CSL or bodily injury each person
Select
CSL
Bodily injury each per
Limit amount ($)
Bodily injury each accident($)
Property damage($)
Physical Damage
Coverages: comprehensive and specified perils
Comprehensive
Select
Yes
No
Specified perils
Select
Yes
No
All owned autos
Select
Yes
No
Owned private pass autos only
Select
Yes
No
Owned autos other than private pass
Select
Yes
No
Specifically described autos
Select
Yes
No
Autos on consignment and dealer autos
Select
Yes
No
Coverages: collision
All owned autos
Select
Yes
No
Owned private pass autos only
Select
Yes
No
Owned autos other than private pass
Select
Yes
No
Specifically described autos
Select
Yes
No
Autos on consignment and dealer autos
Select
Yes
No
Deductible per loss ($)
Maximum deductible per loss ($)
Other
Covered auto symbols???
Location 1
Location number
Limit amount ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Location 2
Location number
Limit amount ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Location 3
Location number
Limit amount ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Garage Keepers
Legal liability
Select
Yes
No
Direct basis
Select
Yes
No
Type of direct basis (if applicable)
Select
Primary
Excess
Coverages: comprehensive and specified perils
Comprehensive coverage
Select
Yes
No
Specified perils coverage
Select
Yes
No
Autos left for service/repairs/storage
Select
Yes
No
Location 1
Location number
Limit ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Location 2
Location number
Limit ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Location 3
Location number
Limit ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Coverages: collision
Autos left for service/repairs/storage
Select
Yes
No
Location 1
Location number
Limit amount ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Location 2
Location number
Limit amount ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Location 3
Location number
Limit amount ($)
Deductible per auto ($)
Maximum deductible per loss ($)
Other
Physical damage reporting period
Dealer number/Repairer plates
Number transportation plates
Number of hoists
Temporary location limit ($)
Transit limit ($)
53 Loveton Circle, Suite 120 • Sparks, MD 21152
Phone • 1.800.926.8085 • 410.472.1620 • Fax • 410.472.1897
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