Acord Garage Keepers Application

Page 4 of 4 national producer number required in.

Acord garage keepers application.

Texas garage and dealers date mm dd yyyy coverages limits section the acord name and logo are registered marks of acord. He she represents that the answers are true correct and complete to the best of his her knowledge. I have made my selection on this application and i have read and completed the umpd portion of the california auto supplement acord 61 ca. Acord 128 2014 12 the undersigned is an authorized representative of the applicant and represents that reasonable inquiry has been made to obtain the answers to questions on this application.

Garage auto coverage options limits r non owned included automatically for auto service plus program hired estimated cost of hire bfdoc ca9910 need all individuals names rental reimbursement ca9923 30 per day for 30 days r broadened garage coverages ca2514 included automatically for auto service plus program. Service or repair shops coverages limits use acord 138 for your state to provide coverages limits information non dealers premises operations. Enter the liability limit sum of all autos being covered per each location. The location number for the garage keepers coverages should correspond to a location number documented on the acord 125.

Acord 0138 ca garage and dealers 2016 02. Date mm dd yyyy annual gross sales number of gallons of gas pumped per year. The acord name and logo are registered marks of acord page 1 of 3 garage and dealers section agency customer id. Garage and dealers section the following provides the user with basic instructions for completing acord 128 garage dealers section.

Endorsements remarks acord 101 additional remarks schedule may be attached if more space is required effective date named insured s policy number carrier naic code agency page 1 of 2 agency customer id. Garage keepers enter the limit for each location of autos ded per loss. The acord name. This form has been designed to handle the basic underwriting needs for automobile service operations and automobile dealers space is provided to enter driver information for up to eight drivers.

Attach to acord 128 applicant s signature date producer s signature national producer number coverages limits section other collision 30 legal liability direct basis primary excess loc deductible per auto maximum garage keepers enter the limit for each location of autos ded per loss perils 30 specified comp. I understand that the coverage selection and limit choices indicated here or in any state supplement will apply to all. Garage keepers enter the limit for each location of autos ded per loss. Enter the limits for each location.