Eehall. Com Auto Dealer Supplemental Application
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 QuoteMe@EdwardEHall.com EEHall.Com
Auto Dealer Supplemental Application The following items have been identified as important to our underwriting of franchised auto dealers. Some of these require a simple yes or no answer and some will require a narrative response. This application must be completed when sending in a new submission or renewing a policy.
1. Date of Application: 2. Name of Dealership: 3. Federal ID#: 4. Proposed Effective Date: Class I Employees: Class I Regular Operators are any Employees whose principal duty involves the operation of covered autos; Demos, Parts Drivers, Valet Drivers, Courtesy Drivers and or any employee who is furnished demos such as Salespersons. 5. Number of Regular Operators Part Time Full Time 6. All Other Operators Part Time Full Time Class II Non Employees: Any of the following persons who are regularly furnished with a covered auto: Inactive-Proprietors, Partners or Officers and their relatives and the relatives of any person described in Class I. 7. Number of Employees Under Age 25 All Others 8. Names of Owner(s)/Principal(s): Active Check Last Name First Name Title If Yes 9. Name of person responsible for Deductible Recoveries: Telephone No.: Email: 10. Management has suitable industry/management experience: Yes No Explain: 11. Date Franchise Established: 12. Franchise(s) held: 13. Operations Include: New Car Sales Used Car Sales Body Shop Service 14. What percentage of Gross Sales are derived from: New Car Sales % Used Car Sales % Service % Other: % 15. Other operations on the facilities: 16. Maximum number of vehicles used in business: Wreckers/Rollbacks (Owned): Service Trucks: Parts Delivery Vehicles: Rental Vehicles:
Owners: Managers: Employees: Non-Employees: 18. Provide a narrative on Demo Privileges. What type of employee is allowed a demo? Attach Demo Agreement: 19. Please describe relationship for all Non Employee Demo Drivers: 20. List names of ALL individuals or organizations that the dealership loans vehicles on a long or short term basis (i.e. daily, weekend, etc). That includes politicians, university officials, professional athletes, high schools, etc. PLEASE NOTE THESE INDIVIDUALS WILL BE RATED AS NON EMPLOYEES ON YOUR POLICY AND PREMIUM WILL BE CHARGED. Last Name First Name License (No., State) DOB FOR CONSIDERATION OF THIS APPLICATION OF INSURANCE PLEASE PROVIDE CERTIFICATES OF INSURANCE FROM ABOVE INDIVIDUALS OR ORGANIZATIONS NAMING APPLICANT ADDITIONAL INSURED. 21. Number of Employees in the Following Classifications (as of the date of this application): Sales Manager Officer Manager Porters Service Manager Sales Service Tech Parts Manager Body Shop Parts Dept. F & I Manager Clerical Parts Delivery
If yes, has the procedure been reviewed by a labor attorney? Yes No Approved Application Form Yes No Telephone background check Yes No Motor Vehicle check Yes No Personal interview witnessed Yes No References checked Yes No Road test given Yes No Drug screening test required Yes No Other: Yes No Customer Use of Dealer Owned Vehicles: 23. Are vehicles test driven without employee in vehicle? Yes No If yes, please explain below under what circumstances an employee would not accompany the customer. Note: Test drive accidents are less likely to happen if customer is accompanied by an employee. Explanation: 24. Is there a predetermined route established for Customer Test Drives and recently serviced vehicles? Yes No If yes, please describe the route below. Note: Statistics show a route mainly consisting of right hand turns is less likely to lead to an accident.
Customer Use of Dealer Owned Vehicles continued: Is Customer’s driver’s license checked? Yes No Is copy made? Yes No Proof of insurance required? Yes No Is copy made? Yes No Is Customer’s insurance verified? Yes No
If yes, explain in specific detail below. Note: Loaned vehicles create a large liability exposure to your dealership, recommending a car rental operation instead (i.e. Budget, Hertz, Enterprise) eliminates this exposure. Attach copy of Loaner Agreement 26. Do you allow 24 hour Test Drives? Yes No If yes, Do you have a specific insurance policy covering this exposure? Yes No What is the name of the carrier? What are your Limits of Insurance? Please attach a copy of the policy.
Maximum number of Customer’s Cars on premises at any one time: Maximum value of Customer’s vehicles on premises at any one time: $ How are vehicles protected? Check all that apply. Fenced lots with lockable gates Watchmen Alarm Systems Key Control – Describe: Are all customer vehicles protected by the above? Please describe under what circumstance a customer’s vehicle would not be protected by the above:
Do you confirm these vehicles have Physical Damage coverage? Yes No Note: Certificates of Insurance should be obtained from consignee. 28. Service and Repair Operations: Is the public barred from the service area? Yes No Service and Repair Operations continued: Are signs posted to that effect? Yes No Note: Extremely large losses can result from customers entering service areas. Please type or write below what posted signs state.
Please describe in detail how you handle customer complaints: Do you have an arbitration agreement with clients to resolve possible disputes? Yes No Do you video tape any transactions with customers? Yes No If yes, what type of transactions? Are Technicians factory trained? Yes No What technicians are ASE Certified? Name: Name: Name: Name:
Does service order contain a “Hold Harmless” clause for personal articles left in vehicles? Yes No Does Applicant perform vehicle conversions? Yes No Is location to be insured in a heavily traveled area? Yes No Does Applicant own a sponsor a car for racing? Yes No Does Applicant perform any tire recapping or retreading? Yes No Does Applicant operate a Motorcycle sales operation? Yes No RV sales operation? Yes No Public service gas station? Yes No Public storage and/or parking garage? Yes No Public car wash? Yes No Public Towing Operation Yes No Salvage operation Yes No Own or operate any water or aircraft Yes No Are parking areas and traffic flow lanes clearly defined? Yes No Are surfaces of steps, ramps and floors properly treated to prevent slips and falls? Yes No Are customer entrance and exit ramps built to code? Yes No Does Applicant book or own vehicle leases? Yes No If yes, how many?
Leasing Operations Supplement & EEHAutoDealer Program does not write this coverage within our Leasing Contingent Liability Garage Package Policy. Please contact Kathleen Everhart, Tri Arc Financial 800-446-5960 or via email Kathy@triarcfs.com. 30. Drive Other Car (DOC) Coverage: Please provide a list of the individuals to be insured under the Drive Other Car Endorsement. Please indicate relationship if applicable. Last Name First Name License (No., State & DOB) 31. Does Insured have the following in place: A person or group responsible for information security Yes No A Virus Protection Program Yes No A firewall protection program Yes No A software update process that includes anti-virus and software release updates? Yes No An Information Security Policy currently in place documenting security responsibilities and testing? Yes No An Information Security Incident Response Plan currently in place covering unintended release, theft or loss of personal Information? Yes No g. Encrypt all sensitive and personally identifiable information Yes No h. Total number of vehicles sold annually? New: Used: i. What is the average cost of vehicles sold? New: Used: 32. List of Named Insureds in addition to the Applicant. Please include addresses and function. Name Address
COVERAGE IS NOT BINDING UNTIL SPECIFICALLY AUTHORIZED BY EDWARD E. HALL AUTODEALER PROGRAM AND THEN ONLY AS OF THE COMMENCEMENT DATE OF SAID AUTHORIZATION AND IN ACCORDANCE WITH ALL TERMS THEREOF, AND THE SAID APPLICANT HEREBY COVENANTS AND AGREES THAT THE FOREGOING STATEMENTS AND ANSWERS ARE A JUST, FULL AND TRUE EXPOSITION OF ALLA THE FACTS AND CIRCUMSTANCES WITH REGARD TO THE RISK TO BE INSURED, INSOFAR AS THE SAME ARE KNOWN TO THE APPLICANT: AND THE SAME ARE HEREBY MADE THE BASIS AND A CONDITION OF THE INSURANCE, AND A WARRANTY ON THE PART OF THE INSURED. WARNING NEW JERSEY: “ANY PERSON WHO INCLUDES ANY FALSE OR MISLEADING INFORMATION ON AN APPLICATION FOR AN INSURANCE POLICY IS SUBJECT TO CRIMINAL AND CIVIL PENALTIES.” ALL OTHER STATES: “ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT THEY ARE FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT MAY BE GUILTY OF INSURANCE FRAUD.” NEW YORK: “ANY PERSON WHO KNOWLINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR COMMERCIAL INSURANCE OR STATEMENT OF CLAIM FOR ANY COMMERCIAL OR PERSONAL INSURANCE BENEFITS CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, AND ANY PERSON WHO, IN CONNTECTION WITH SUCH APPLICATION OR CLAIM, KNOWLINGLY MAKES OR KNOWINGLY ASSISTS, ABETS, SOLICITS OR CONSPIRES WITH ANOTHER TO MAKE A FALSE REPORT OF THE THEFT, DESTRUTION, DAMAGE OR CONVERSION OF ANY MOTOR VEHICLE TO A LAW ENFORCEMENT AGENCY, THE DEPARTMENT OF MOTOR VEHICLES OR AN INSURANCE COMPANY, COMMITS A FRAUDLENT INSURANCE ACT, WHICH IS A CRIME AND SHALL ALSO BE SUJECT TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARS AND THE VALUE OF THE SUBJECT MOTOR VEHICLE OR STATE CLAIM FOR EACH VIOLATION.” Signature of Applicant: Date: Print Name: Title: Signature of Producer: Date: Page of Rev 06 14 13 Directory: applications applications -> No Child Left Behind Blue Ribbon Schools Program U. S. Department of Education Cover Sheet applications -> Covering letter applications -> Midterm Review Questions Summer 2014 (Kesden) Networks applications -> Amps (Advanced Mobile Phone System) was approved by the fcc I e. Federal communication commission and first used in Chicago. Amps uses a frequencies between 824 megahertz (MHz) and 894 mhz for analog cell phones Digital applications -> Aea-09-004 Renewable Energy Grant Application Second Round, November 10, 2008 Resource Monitoring, Final Design, Permitting, and Construction project applications -> P. O. Box 525 319 Central Ave applications -> Application Forms and Instructions applications -> Application Forms and Instructions applications -> Oracle Accelerate for Midsize Companies Specialization How to achieve Oracle Accelerate for Midsize Companies Specialization? Download 91.88 Kb. Share with your friends:
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