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LANCER <br /> I N S U R,\N CF <br /> i lre Di+±:reiWe"tats Af ri:ltde•. <br /> INSURED NAME: City of Decatur DBA Decatur Public Transit System <br /> GENERAL LIABILITY INFORMATION <br /> 1. General Liability Limit:$ 5,000,000 <br /> 2. Please Indicate Square Feet For: <br /> Owned(0) Office Repair Outside Vacant <br /> .Location or Leased(L) Area Garage Parking Storage Land <br /> 555 East Wood St 3700 SF <br /> 3. Other General Liability Exposures-Describe and provide Basis of Rating: <br /> A. Are there any Underground Storage Tanks on the premises? ❑ Yes ®No <br /> If Yes,please identify the Type and Location: <br /> 4. Do you have any contractual agreements with others? ❑ Yes ®No Please include copies oj'contracts. <br /> 5. List General Liability Losses by Year for Current and fast Four(4)Years. Please attach Loss Runs. <br /> Current Year: <br /> l - 1 <br /> 1 - / <br /> f - 1 <br /> 6. General Liability Comments: <br /> GARAGE LIABILITY INFORMATION <br /> 1. Gara e Liability Limit: S <br /> A. Ho any times during the past 12 months have you serviced or repaired a ent of other Operators? <br /> B. Nature of Repairs. <br /> C. If any of the following typ of vehicles are sold or repaired, ' nate with a®. Also provide percentage of sales/repairs. <br /> ❑Motorcycles % ❑Private Passenger r % ❑Semi's/Trailers % <br /> ❑Pick-ups/Vans °!o rucks or Tr Tractors % ❑Other(Specify) <br /> D. Do you modify vehicles? ❑ Yes Q No <br /> Style: ❑ Yes ❑No Performan Yes No Handling: ❑Yes ❑No <br /> If Yes,explain: <br /> E. Do you install Roll Bars? es ❑No Do yo raighten chassis? ❑Yes ❑No <br /> Re-cap tires? ❑ s ❑No Do you or ` <br /> Do you weld'? Yes ❑No If Yes,provide details: <br /> you ever`stretched vehicles? Yes ❑No <br /> F. Do you rent or n autos to your customers white theirs are left for service? ❑ ❑No <br /> If Yes,e ain: <br /> If Y ,do you require evidence of insurance from customer? ❑Yes ❑No <br /> Do your sales personnel usually accompany customers on"Test"or"Demo"rides? ❑Yes ❑No <br /> uenerallGarage Liability Supplement Application(09/13) Page 1 of 4 <br />