Genesee General Genesee General of Colorado Gensee Special Brokerage GenPay Premium Finance Contact Us

On Line Quote Request-Garage

Please fill out the information below to receive your quote!
One of our underwriters will contact you within the next 24 hours.
Note: depending on the description of operations, a supplemental application may be required.
(*) Signifies a required field below.
Producer  
*AGENCY NAME:
*PHONE #:
FAX #:
*EMAIL:
CONTACT NAME:
Insured  
*NAME:
LOCATION ADDRESS:
Street:
 
City: State: Zip:
   Click if More than 1 Location
 
INSURED'S WEBSITE:
*YEARS IN BUS:
YEARS OF EXPERIENCE:
DESCRIPTION OF OPERATIONS:
DOES INSURED SELL NEW OR USED AUTO PARTS?  No      Yes
DOES APPLICANT HAVE A UL APPROVED SPRAY BOOTH?  No      Yes        If yes, is it approved?   
Employee and Non-Employee Information
  You must complete the following information for all employees, drivers, and household members.
  ** Violations/accidents for last 3 yrs
EMP 1
Name: Age: Violations:**
Job Duties:
Hours Worked:
Auto Use:
 Click Here for additional employee information
Prior Carrier & Loss History (mm/dd/yyyy)
*CARRIER:

Carrier: Policy Premium:
If there is no prior insurance, check the box.
3 YEAR PRIOR LOSS HISTORY:
Policy Period: Total Paid: Number of Claims:
If there are no prior losses, check the box.
Coverages and Limits
GARAGE LIABILITY:
Limit of Liability Deductible
Auto   Each Accident
Other Than Auto   Each Accident
Auto   Aggregate Limit
   
DEALERS OPEN LOT:
Coverages
 Comprehensive
 Specified Perils
 Collision
 False Pretense 		Limit of Coverage
 Limit Per Location
 Limit Per Auto 		Deductible
 Other Than Collision
 Collision
   
GARAGEKEEPERS:
Coverages
 Comprehensive
 Collision
 Specified Perils 		Limit of Coverage
 Limit Per Location
 Limit Per Auto 		Deductible
 Other Than Collision
 Collision
    Select one of the following:
 Legal Liability    Direct Excess    Direct Primary
   
LOT PROTECTION:
Select one of the following that best describes how the applicant's premises is protected:
Standard Open Lot - Open Parking storage Lots enclosed on all sides by a metal cyclone or equivalent fence not less than six feet in height; or a combination gates, posts, or heavy chains, locks or bounded on one or more sides by the wall or wall of building with no unprotected openings.
Non-Standard Open Lot - Lots that are all other open lot locations; or unroofed space and buildings not securely enclosed and locked when unattended.
Unprotected - Open storage with no theft barriers.
Building - Storage of autos in secured, locked building.
Other   
   
MISC COVERAGES:
In-Tow Coverage For-Hire Not-For-Hire
   Limit Per Tow Truck  # of Tow Trucks
   
 
Medical Payments  Auto  Garage Operations
   
 
 Broadened Coverage (includes Personal Injury & $50,000 Fire Legal)
 Fire Legal Liability    Limit  
 Damage to Rented Premises    Limit  
  Personal Injury Liability
 Broad Form Products
   
 
 Additional Insured Name:
 Waiver of Subrogation Address:
  Insurable Interest:
   
 
Uninsured Motorists Coverage  Each Accident # of Dealer Tags:
Underinsured Motorists Coverage  Each Accident
   
 
Personal Injury Protection  Per Statute
   
 
Radius of Pickup & Delivery  None    0-300 Miles    301-500 Miles
 501-1000 Miles    1000+ Miles  
   
 
Dealer's Errors & Omissions  Title E&O  Truth In Lending E&O
   Federal Odometer E&O  Insurance Agents E&O
Service Vehicles  
  Include Tow Trucks, Car Haulers & Wreckers or Specifically Described Autos:
   
  Filings Required? No Yes    If yes, list MC# or Certificate #   

VEHICLES:
Year: Make: Body Type: Serial #: GVW: Phy Damage Limit:
  Loss Payee   
ADDITIONAL INSURED:
Name:
Address:
Insurable Interest:
  Optional Coverage Not Listed:   
Comments  
COMMENTS: