Garage Form

Main Content of the Garage Form and Link to the PDF Application.

General Information
Property Coverage
Garage Liability

GENERAL INFORMATION
Legal Name:
Corporation/LLC Partnership Individual Joint Venture Subsidiary Other
Do you operate under a DBA?	Yes No
DBA Name:
Are you a New Venture?	Yes No
Year Established:
Are you a SEMA Member?	Yes No
Contact Name/Title:
Contact Phone:
Email Address:
Mailing Address
Mailing Address:		City:
State:		Zip:
Physical Address
Premise Address:		City:
State:		Zip:
state nature of business and description of business operations

Prior Coverage Information
Coverage	Carrier	Expiration Date	Expiring Premium
Liability
Property
Auto
Workers Comp
Umbrella
Have you had any losses in the past 3 years? (If yes please attach loss reports for the past 4 years.)	Yes No
How did you hear about us?	SEMA Magazine Internet Mail Referral:

Property Coverage	Limit
Building Limit (if owned or required by lease)	$
*Content Limit (Total Assets)	$
Mobile Tool Floater (Work performed off premise)	Optional Limits Available $5000 $10,000 Other: $
*Business Interruption Limit (Money needed to post loss)	$
Garage Keepers (Vehicles in your care, custody & control)	$ Per Vehicle	$ Total Per Loss
*Central Station Alarm required for theft coverage to apply.
Building Information
Describe Neighborhood:	Residential Commercial Industrial
Construction Type:	Wood Frame Masonry-Wood Roof & Floors Masonry-Concrete & Steel Roof/Floors Fire Resistive
Building is:	Inside City Limits Outside City Limits
Building is:	Owned Rented Leased
# of Stories:
Age of Building:
Square Footage:
Building Updates Made:	Wiring Plumbing Roofing Heating & Air		Year Made:
Do you occupy the entire premise?	Yes No
Do you lease part of the premise to others?	Yes No
Do you have an alarm system?	Yes No	Type: Smoke Fire Burglar Other
Your Security System is:	Central Station Policy Gong Alarm Video Surveillance
Do you have?	Fire Extinguishers Sprinkler System	% of Building Sprinklered
How many miles from Eastern or Gulf Coast?	Wind coverage restricted if within 25 miles of ocean.

General / Garage Liability Section
Limits	Mandatory Coverage	Excess Liability	Policy Details
$2,000,000	General Policy Aggregate	$1,000,000 $2,000,000 $3,000,000 Other: $	Coverage: Occurrence Rating Basis: Gross Sales Audit Type: Annual Per Occ. Deductible $1,000 Non-Owned Auto Liability.
$2,000,000	Product Completed Operations Aggregate
$2,000,000	Personal & Advertising Liability
$2,000,000	Each Occurrence Limit
$100,000	Damage to Premises Rented to You
$5,000	Medical Payment
Liability Rating Basis
Auto Parts Installation	$
Auto Parts Retail	$
Auto Parts Distribution*	$
Auto Parts Manufacturing	$ Operational Parts Manufactured or Imported
Auto Parts Manufacturing	$ Cosmetic Parts Manufactured or Imported
*Please note Importing of Foreign Products require a certificate of insurance from manufacturer or distributor.
Operational Hazards
How are vehicles stored?	Inside Outside in Fenced Gated Lot Outside in Open Lot Public Street
Are vehicles:	Picked up by you Delivered to customers Transported by motor carrier
If delivered, how many vehicles per deliver?		Radius of Deliveries?
Do you have any motor vehicle plates?	Yes No - If yes: Manufacturers Dealers Other
Do you provide loaner cars or rent vehicles to customers?	Yes No	Tow Trucks Owned?		Yes No
Total number of employees?		Annual Payroll $
Do you have a paint booth?	Yes No	If yes how often do you have it inspected?
Do you manufacture anything?	Yes No	Please explain:
Any losses in the past 5 years?	Yes No	Please explain:
Do you name anyone as an additional named insured?	Yes No	Please explain:
Product Qualifiers
Sunroofs Running Boards Custom Wheels & Tires Auto Upholstery Mobile Electronics	Auxiliary Lighting Exhaust Systems Grills / Grill Guards Exterior Trim Interior Trim	Truck Cap & Tonneau Covers Suspensions (Lift Kits up to 8 inches Only) Trailer Hitches (Bolt on Kits Only)
Do you install any other parts? If so please explain:

We have been with Alliant Insurance Services and the SEIA program since 2004. Alliant has not only provided Walker Evans Racing with great service, but have saved us thousands of dollars in premium over the years while improving our coverages. They are the aftermarket experts we rely on to protect our company. We highly recommend doing business with them.

Walker Evans, Walker Evans Racing

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