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Amwins Garage Form Repeater (Not Finished)

% of A/C service (number only) % *
% of brake service (number only) % *
% of cooling service (number only) % *
% of electrical service (number only) % *
% of exhaust service (number only) % *
% of frame work service (number only) % *
Any frame cutting/stretching or shortening/welding *
- Yes
- No
Explain frame cutting/stretching or shortening/welding *
% of front end service (number only) % *
% of fuel systems service (number only) % *
% of oil change service (number only) % *
% of paint and body work (number only) % *
% of shock service (number only) % *
% of tune ups (number only) % *
% of welding (number only) % *
Total percentage (Must equal 100%) % *
Loaner vehicles provided *
- Yes
- No
Rental/Leasing operations *
- Yes
- No
"Authorized Personnel Only" or "Employees Only" signs posted in restricted areas *
- Yes
- No
Used or salvage parts installed *
- Yes
- No
Describe used or salvage parts installed *
Vehicles test driven *
- Yes
- No
Describe how vehicles are test driven *
Other business operations at this location *
- Yes
- No
Explain other business operations at this location *
Does risk sponsor, repair, or engage in racing or competitive activities *
- Yes
- No
Explain risk sponsor, repair, or engage in racing or competitive activities *
General Information
General Repair - Service
Service Operations - Percentages
Storage and Disposal Procedures
Security
Fire Protection
Property Information
Building-Updates
Liability
Vehicle Storage(s)
Vehicle Key Handling
Hoist
Towing
Dealer Section
Employee and Non-employee Information
Interview date (mm/dd/yyyy) *
- Month
- Day
- Year
Person interviewed *
Neighborhood type *
- Commercial
- Residential
- Commercial and Residential
Insured's hours of operations (Example: Mon-Fri 8-5) *
Distance to tidal water *
Any previous losses *
- Yes
- No
Describe any prior losses *
Website *
Description of operations *
Mark all that apply *
- General Repair - Service
- Towing
- Dealers Section
Annual sales dollars *
Number of bays (numbers only - 0 if none) *
Number of service pits (numbers only - 0 if none) *
Paint booth *
- Yes
- No
Is it UL approved *
- Yes
- No
Self-service vehicle wash available for the general public *
- Yes
- No
If yes, self-service wash sales (numbers only) dollars *
Propane sales to the public *
- Yes
- No
If yes, how many gallons gallons *
Propane sales (numbers only) dollars *
Burglar alarm *
- Central alarm
- Local alarm
- None observed
Name of monitoring company *
Motion sensors *
- Yes
- No
Surveillance cameras *
- Yes
- No
Free of guard or aggressive dogs *
- Yes
- No
Break-ins last 12 months *
- Yes
- No
- Unknown
Explain break-ins in the last 12 months *
Number of fire extinguishers *
Type of fire extinguishers *
- ABC
- AB
- K-class
Fire extinguishers currently tagged *
- Yes
- No
Last service date *
- Month
- Day
- Year
Is there a fire alarm *
- Yes
- No
- None observed
Fire alarm properly serviced *
- Yes
- No
Fire alarm type *
- Central
- Local
Rags tainted with oils, fuels, or solvents disposed of and stored in self-closing, fire resistive containers *
- Yes
- No
- N/A
Are waste solvents, oil, gasoline, etc. removed by a licensed waste removal contractor *
- Yes
- No
- N/A
Explain waste solvents, oil, gasoline, etc. removed by a licensed waste removal contractor *
Holding tank used for motor oil and fluids *
- Yes
- No
Explain holding tank for used motor oil and fluids size, location and what's stored *
Are all paints and other flammables or combustible materials on site stored in a UL-rated flammable storage cabinet *
- Yes
- No
Explain combustibles not in UL-rated flammable storage cabinet *
Number of buildings at this location *
Brief description of building(s) *
Construction type *
Year built (yyyy - Example: 1981) *
Foundation type *
Any foundation defects/sinking/cracks *
- Yes
- No
Explain obvious defects, sinking or cracks *
Is there a basement *
- Yes
- No
Check all exterior wall finishes that apply *
- Brick veneer
- Wood siding
- Hardiplank
- Stucco
- Concrete block
- Stone veneer
- Wood shake
- Aluminum siding
- Vinyl siding
- Metal siding
- Log
- Asbestos siding
Any wall irregularities/defects/cracks *
- Yes
- No
Explain any obvious wall/structural irregularities, defects, or cracks *
Sidewalks/walkways/exterior ground areas inspected *
Parking/driveway area condition *
Exterior lighting condition *
Interior lighting condition *
Marked exits/egress *
Condition of floors inspected *
Public area condition *
HVAC (Heating/Cooling) type *
Wiring type *
- Copper
- Aluminum
- Knob and Tube
- Not Confirmed
Overcurrent protection type *
Electric panel type *
- Federal Pacific/Stab-Lok
- Zinsco/Kearney
- GTE-Sylvania
- Challenger
- Magnetrip
- General Electric
- Square D
- Cutler Hammer
- Siemens
- Eaton
- Schneider
- Westinghouse
- Other Brand
- Label not visible
- Electrical panel not accessible
Other electric panel brand *
Age of building determined by *
- Annual Inspection
- Service Contract
Plumbing year updated (yyyy - Example 1981 or write undetermined) *
Roof age/Last update (Example - 5 years or write no updates) *
Roof shape/style *
Roof covering *
Current roof condition *
Roof support (What's supporting the roof - example: walls, columns, etc.) *
Roof deck construction (What it is made of - example: wood, stone, aluminum, etc.) *
Exterior wall support construction (What's supporting the walls - example: columns, beams, anchors, etc.) *
Rating definition (How is the building rated - example: stars, green building rating system, etc.) *
Keys kept in lockbox or secure location *
- Yes
- No
Explain *
Key storage type *
- Customer
- Owned
- Vehicles for sale
Keys secured during the day *
- Yes
- No
Keys locked up and secured at night *
- Yes
- No
Burglar alarm present and monitored by central station *
- Yes
- No
Number of vehicle storage units in lot *
Maximum number of vehicles stored in lot(s) *
Is the vehicle lot secured *
- Yes
- No
Describe lot security *
- Fence
- Post and Chain
- Fence/Post and Chain
- Other
Please explain *
Animals on premises *
- Yes
- No
If yes - what breed, and are they kept in a kennel *
Please explain *
Burglar alarm *
- Yes
- No
If yes - what monitoring company *
Please explain *
Fire alarm *
- Yes
- No
If yes - what monitoring company *
Please explain *
Maximum number of vehicles kept overnight *
Average number of vehicles kept overnight *
Overnight vehicle storage inside or outside *
- Inside
- Outside
Inside or outside storage *
- Inside
- Outside
Explain *
Vehicles stored at other locations *
- Yes
- No
Square footage of building (sq ft) sq ft *
Parking lot and customer premises well lit *
- Yes
- No
Please explain *
Smooth and level parking lot *
- Yes
- No
Please explain *
Other smooth and level customer walking surfaces *
- Yes
- No
Please explain *
Free of attractive nuisance hazards *
- Yes
- No
Please explain *
Free of vandalism and graffiti *
- Yes
- No
Please explain *
Interior customer lighting adequate *
- Yes
- No
Please explain *
Customer areas free of slip/trip hazards *
- Yes
- No
Please explain *
Good housekeeping *
- Yes
- No
Please explain *
Adequate customer area interior maintenance *
- Yes
- No
Please explain *
Warning signs for customers near danger areas *
- Yes
- No
Adequate number of fire extinguishers *
- Yes
- No
Extinguishers serviced last year *
- Yes
- No
Vehicle hauling and towing services *
- Yes
- No
Number of tow trucks *
US DOT Number *
% of tow trucks for hire % *
% of tow trucks for insured use % *
Tow trucks equipped with GPS *
- Yes
- No
Operational radius (How far trucks can conduct business in miles) miles *
Impound yard present *
- Yes
- No
On hook coverage present *
- Yes
- No
Repossession services available *
- Yes
- No
Towing rotation 24/7 *
- Yes
- No
Vehicle hoists present *
- Yes
- No
Hoist type *
How many hydraulic hoists *
Hoist load capacity (in lbs) lbs *
Are contract drivers used (not from an agency) *
- Yes
- No
Estimated annual gross sales (in $) *
Number of dealer plates *
Parking lot size (in sq ft) sq ft *
Titles transferred during time of sale *
- Yes
- No
MVR's obtained pre-employment and annually *
- Yes
- No
Average radius (in miles) miles *
Average number of vehicles stored inside (daytime) *
Average number of vehicles stored outside (daytime) *
Average number of vehicles stored inside (nighttime) *
Average number of vehicles stored outside (nighttime) *
Autos sold retail or wholesale *
- Retail
- Wholesale
- Other
Transporter plates (NOT dealer plates) not issued for a specific auto *
- Yes
- No
List registration plate numbers *
Describe how these plates are being used *
Type of company vehicles *
- Private Passenger
- Pickup Trucks
- Vans
- Tow Trucks
- Box Trucks
- Other
How are company vehicles used *
Number of company (service) vehicles *
Registered to the business *
- Yes
- No
- Other
Travel radius of company vehicles (in miles) miles *
Loaner or rental vehicle units used *
- Yes
- No
Loc number *
Name *
Date of birth (mm/dd/yyyy) *
- Month
- Day
- Year
Has CDL *
- Yes
- No
Hours worked per week *
- Fulltime (over 20 hrs/week)
- Part-time (20 hrs or less/week)
- Non-employee
Current status *
Other status *
Auto use *
- Business and Personal Use
- Business Use Only
- No Use of any Auto
Loc number *
Name *
Date of birth (mm/dd/yyyy) *
- Month
- Day
- Year
Has CDL *
- Yes
- No
Hours worked per week *
- Fulltime (over 20 hrs/week)
- Part-time (20 hrs or less/week)
- Non-employee
Current status *
Other status *
Auto use *
- Business and Personal Use
- Business Use Only
- No Use of any Auto
Employee and Non-employee Information

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