Amwins Garage Form Repeater (Not Finished) - Drag N' Drop FormBuilder

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