R2017-116 Liability Insurance Coverage for Transit System

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G. Do you drive or otherwise transport vehicles for sale or repair or pick-up more than 50 miles from your location? Yes D No NOTE: Dealer's Physical Damage Coverage is limited to 50 mile radius unless li 'cation is removed. is your average trip? Miles What is your maximum t ' Miles K Do you o -any tow trucks or autos sent to service customer vehicles off your pre ' s? ❑Yes F1 No 1. Do you handle a utane or propane containers? ❑Yes ❑No J. Do you have any guar s? ❑Yes ❑No K. Physical damage and Garage Yes Legal Liability: ❑Yes o 1. Is your lot completely en ed by chain-link fe or chain and posts not more than 4'apart? ❑Yes [j No 2. Is your lot well lit at night? M N 3. Is your lot regularly patrolled by a se uard? ❑Yes [--]No 4. Do you ever leave keys in vehi while open usiness. ❑ Yes � []No 5. What percentage of vehicl are generally stored insi a uilding? a. Owned Vehicle % b. Non-Own ehicles: L. Estimated receipts fr work to other operators units: M. Actual receipts m work to other operators units the past year: N. Number echanics: O. Me nics Weekly Payroll: GARAGEKEEPERS LEGAL LIABILITY INFORMATION 2. Garagekeep s Legal Liability Limit: $ A. Deducti Desired: I. Collision ductible: $ 2. Specified Peri s. $ B. List of Locations with Lim) or each: Location: Limits: $ Location: Limits: $ Location: Limits: $ Location: Limits: $ C. List Garage Liability and Garagekeeper osses(Separately)for rrent and Past Four(4)Years: Please Attach Loss Runs. Current Year: 1 - . LPleaseubmit Update Loss Runs Valuated: No Later Than 60 Days With This Application. PLEASE READ THE FOLLOWING CAREFULLY BEFORE YOU SIGN THIS APPLICATION I hereby apply for the insurance indicated above and represent that: 1)I have read this application. 2)The limits and coverages requested were selected by me. 3)All statements herein are true and accurate,to the best of my knowledge,and no material facts have been suppressed or misstated. I understand that misrepresentation or omission of material facts will be cause for cancellation and may void coverage. 4)By signing this application,I authorize the insurer to obtain copies of motor vehicle reports for underwriting the indicated insurance, as well as the right to examine or inspect files,records,documents and equipment in order to determine the accuracy of the information stated herein. The completion of this application creates no express or implied obligation on the part of the insurer or its manager to offer a quotation or provide insurance as requested in this application and survey. If the insurance is provided,the policy will only cover the vehicles listed on the attached schedule for the coverages agreed. You must immediately notify the insurer in writing if there is any change in your equipment or operations,and all accidents must be reported promptly regardless of severity or fault. General/Garage Liability Supplement Application(09113) Page 2 of 4