Illinois Tow Truck and/or Garage Insurance Quote

Quote Urgency:  . Within 24 Hours Within 1 Hour ASAP Customer in Office Waiting (Req'd)

Cell Color Key:	Mandatory for All Quotes	Tow Truck Risks	Garage / Storage Risks
For RED Sections - this is common info for ALL QUOTES. For BLUE Sections - this is info required for TOW TRUCK coverage. For GREEN Sections - this is info required for GARAGE / STORAGE coverage.

Policyholder Info
Titleholder of Vehicle / Owner of Garage					Producing Agency
DBA (if applicable)			Contact Name		Producer Name
Garaging/Location Address			Contact Phone		Producer Phone
Garaging/Loc City	Garaging/Loc State	Garaging/Loc Zip			Producer's E-mail or Fax (Req'd)
Mailing Address (if different from above)			Years in Business
Mailing City	Mailing State	Mailing Zip	Years in Industry

Proposed Effective Date

Ownership of Business . Individual Patnership Corporation LLC

Nature of Business . Towing Only Towing w/ Storage Towing w/ Repair Shop Garage Only

Drivers
Dr#	Name	Date of Birth	Sex	State	Driver's License #	Violations or Accidents (Last 3 years) Describe in Comments Section	Driver Exp
1			. M F
2			. M F
3			. M F
4			. M F
5			. M F
6			. M F
7			. M F
8			. M F

Additional Interests UPDATED!!!! - There is a charge for some additional insured types.  If policy requires additional insureds, they must be entered below for quoted premium to be accurate.
Type	Vehicle #	Name	Address
. AI - Leased Vehicle AI - For a Job AI - Buidling Owner AI - City of Chicago AI - Misc Note in Comments Loss Payee	. 1 2 3 4 5
. AI - Leased Vehicle AI - For a Job AI - Buidling Owner AI - City of Chicago AI - Misc Note in Comments Loss Payee	. 1 2 3 4 5
. AI - Leased Vehicle AI - For a Job AI - Buidling Owner AI - City of Chicago AI - Misc Note in Comments Loss Payee	. 1 2 3 4 5
. AI - Leased Vehicle AI - For a Job AI - Buidling Owner AI - City of Chicago AI - Misc Note in Comments Loss Payee	. 1 2 3 4 5
If you do not know the exact name and address, choose type and enter "TO FOLLOW" in the name and address section.  If more lines are required, note in Comments section.

Prior Insurance
Does risk have prior insurance?     Yes     No
Carrier:	Policy #:	Premium:
Eff Date:	Exp Date:	Renewal to your Office: Yes     No
Is current company non-renewing?     Yes     No
Prior Losses
Has there been any losses in past 3 years?     Yes     No
Date of Loss	Description (including driver and amount paid)
Date of Loss	Description (including driver and amount paid)
Date of Loss	Description (including driver and amount paid)

Tow Truck Section

Vehicle Coverages
Bodily Injury and Property Damage	. $500,000 CSL $750,000 CSL $1,000,000 CSL
Uninsured/Underinsured Motorist Bodily Injury	. $20,000/$40,000 $100,000 CSL $250,000/$500,000
On Hook Coverage	. $25,000 $50,000 $75,000 $100,000
On Hook Deductible	. $250 $500 $750 $1,000

Vehicles
1	Year	Vehicle Classification: (Req'd) . Tow Truck carries 1 Car Tow Truck carries 2 Cars Tow Truck carries 3+ Cars Other - Describe in Comments	(If physical is desired)
	Make	Radius: . 0 - 100 miles 101 - 150 miles 151 - 200 miles 201 - 300 miles 300+ miles	Current Value	Deductible Lia Only $1,000 $2,500
	Model	VIN #
2	Year	Vehicle Classification . Tow Truck carries 1 Car Tow Truck carries 2 Cars Tow Truck carries 3+ Cars Other - Describe in Comments	(If physical is desired)
	Make	Radius . 0 - 100 miles 101 - 150 miles 151 - 200 miles 201 - 300 miles 300+ miles	Current Value	Deductible Lia Only $1,000 $2,500
	Model	VIN #
3	Year	Vehicle Classification . Tow Truck carries 1 Car Tow Truck carries 2 Cars Tow Truck carries 3+ Cars Other - Describe in Comments	(If physical is desired)
	Make	Radius . 0 - 100 miles 101 - 150 miles 151 - 200 miles 201 - 300 miles 300+ miles	Current Value	Deductible Lia Only $1,000 $2,500
	Model	VIN #
4	Year	Vehicle Classification . Tow Truck carries 1 Car Tow Truck carries 2 Cars Tow Truck carries 3+ Cars Other - Describe in Comments	(If physical is desired)
	Make	Radius . 0 - 100 miles 101 - 150 miles 151 - 200 miles 201 - 300 miles 300+ miles	Current Value	Deductible Lia Only $1,000 $2,500
	Model	VIN #
5	Year	Vehicle Classification . Tow Truck carries 1 Car Tow Truck carries 2 Cars Tow Truck carries 3+ Cars Other - Describe in Comments	(If physical is desired)
	Make	Radius . 0 - 100 miles 101 - 150 miles 151 - 200 miles 201 - 300 miles 300+ miles	Current Value	Deductible Lia Only $1,000 $2,500
	Model	VIN #

Tow Truck Underwriting Information
Does risk require a IL Commerce Commission Filing?     Yes     No      If Yes, please complete the following:           ICC Filing #:           Does this application insure all commercial vehicles owned by applicant?     Yes     No                If No, Explain:           Do you ever permit others to operate under your docket number?     Yes     No                If Yes, Explain:
Does risk have any repo or relocation operations?     Yes     No      If Yes, please complete the following:           Explain how risk handles a confrontation of an owner of a vehicle being repossessed?                     Does risk have any drive-away operations?     Yes     No           If yes, please note number of plates in Comments section?
Does risk have a storage lot or building?     Yes     No      If Yes, in applicant's opinion, what is the condition of the storage lot / building? . Excellent Good Fair Poor      If Yes, does risk ever store vehicles for others, other than those used in the pursuit of your business?     Yes     No                If Yes, Explain:
Does risk have any vehicles' that have a GVW of over 45,000 lbs?     Yes     No
Does risk tow any vehicles that weight over 16,000 lbs?     Yes     No
Does risk engage in up righting, extracting, or towing of vehicles containing or leaking hazardous      materials or substances?     Yes     No
What percent of risk's operations snow plowing?      Choose from This Menu 0 - 5% 6% - 10% 11% or more (Req'd) (If garage only select 0 - 5%)
Does risk  belong to a professional towing association?     Yes     No
Does risk "chase" or use any police scanners?     Yes     No
Are there any drivers under the age of 25 or over the age of 65?      Yes     No      If Yes, how many drivers and what are their ages?
Does risk have ANY drivers that have physical/medical impairments including but not limited to alcoholism; diabetes; epilepsy; fainting spells; neurological disorders; seizures; heart/circulatory disorders or ANY mental/physical condition requiring continuous medication?	Yes     No
If Yes, what is the condition and are they under doctor's care for this condition. Please give as much information as possible.
If risk is a storage lot and Garagekeeper's Legal Liability is desired, please complete section below!

Repair Shop / Storage Section

Complete the following ONLY if applicant owns a repair garage -OR- wants garage keepers legal on the storage lot

Garage Liability Coverages
Total Number of Owners/Employees	. 1 or 2 3 4 5 6 7 8 9 10 11 Storage Only
Bodily Injury and Property Damage	. Storage Lot Only $100/$300/$50 $100,000 CSL $200,000 CSL $350,000 CSL $500,000 CSL $750,000 CSL $1,000,000 CSL
Uninsured/Underinsured Motorist Bodily Injury	. Storage Lot Only $20,000/$40,000 $25,000/$50,000 $50,000/$100,000 $100,000/$300,000 $350,000 CSL $500,000 CSL
Medical Payments	. No Coverage $1,000 $2,000
Garagekeeper's Legal	. No Coverage $25,000 $50,000 $75,000 $100,000   Available On Storage Lots Too!
Garagekeeper's Legal Deductible	. No Coverage $250 $500 $750 $1,000   Available On Storage Lots Too!
Do you need a City of Chicago Driveway Permit?	No Yes

Garage Underwriting Information  - Complete only if applicant owns repair garage -OR- selected garage keepers legal coverage from above

Is the risk a franchised or non-franchised auto dealer?     Yes     No

Does risk ever store vehicles for others, other than ones towed by you or cars you work on for your business? Yes     No                If Yes, Explain:

Does risk lack a procedure in place to keep vehicle keys secured?     Yes     No

Does risk store any non-owned vehicles other than inside or within a fenced, lighted lot?     Yes     No

Does risk have any servicing pits?     Yes     No

Does risk sell, rent, or loan vehicles to anyone?     Yes     No

Does risk install trailer hitches or rent trailers?     Yes     No

Is risk a drive-away contractor?     Yes     No      If yes, how many plates do they have?

Is risk a relocator?     Yes     No

In applicant's opinion, what is the condition of the storage lot/building? . Excellent Good Fair Poor

Does risk own, sell, sponsor or repair race cars?     Yes     No

Does risk customize or convert vehicles that alter performance?     Yes     No

Does risk deal in or repair emergency vehicles, ATV's or snowmobiles?     Yes     No

Does risk recap tires or sell recapped tires?     Yes     No

Does risk have a spray booth that is NOT UL approved?     Yes     No

Does risk involve frame straightening other than using a floor model?     Yes     No

Does risk buy or sell salvaged vehicles, repair vehicles with damages totaling more than 60% of vehicle's ACV, or      dismantle or junk vehicles?     Yes     No

Is risk in bankruptcy or legal reorganization?     Yes     No

Does risk use guard dogs, armed guards, or keep firearm on site to protect its premises?     Yes     No

Are there any drivers under the age of 25 or over the age of 65?      Yes     No      If Yes, how many drivers and what are their ages?

Does risk have ANY drivers have physical/medical impairments including but not limited to alcoholism; diabetes; epilepsy; fainting spells; neurological disorders; seizures; heart/circulatory disorders or ANY mental/physical condition requiring continuous medication?     Yes     No

If Yes, what is the condition and are they under doctor's care for this condition. Please give as much information as possible.

Comments

All quotations are subject to satisfactory Moving Violations Report and satisfactory Loss History. (Company fee is fully earned at inception of policy.) Applicant / Agent warrants that above are true to the best of his/her knowledge.

If you wish to have a copy of this submission for your records, you must print page BEFORE submitting.

Please note - There might be a delay upon submission. Do not exit until you receive the "Confirmation Page."

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