AUTO SERVICE PLUS QUESTIONNAIRE - AmTrust North America

FDIC #:
LOC #:
Date:
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AUTO SERVICE PLUS QUESTIONNAIRE
NAMED INSURED:
1. Please enter total number of experience in principle trade.
2. Please enter total number of years of business ownership experience.
3. Do you have an established store front
4. Please indicate total number of employees. Full Time Part Time
5. Number of ASE certified mechanics.
6. Do you have access to current technical service bulletins
7. Do you have scheduled facility inspections and a documented safety program in place
Yes
Yes
No
No
8. General Housekeeping Practices
Minimal
Informal
Formal
9. Smoking allowed on premises
If so, is there a designated smoking area away from building
10. Do you loan or rent vehicles to customers
11. Do you offer mobile repair service
12. Any guard dogs on premises
13. Any other occupants on insured premises
14. Have you ever been cited for any EPA Violations
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
15. Please indicate the percentage of work applicable to: Private Passenger Medium Heavy Trucks
16. Is work done on buses, recreational vehicles, emergency vehicles or any other vehicles used for public transportation
17. Do you specialize in any of the following categories (indicate percentage applicable to each)
Brake Work Transmission Repair Major Engine Overhaul
18. Do you subcontract any work to other service or repair shops
19. Do you engage in any of these activities (check applicable boxes)
New Auto Parts Sales Used Auto Parts Sales New Tire Sales Used Tire Sales
Machine Shop
None Applicable
20. Do you engage in any used auto sales (include autos rebuilt for sale)
If so, how many dealer plates do you currently have
21. Do you operate a wrecker service other than for vehicles brought in for general repairs
Yes
Yes
Yes
Yes
No
No
No
No

22. Do you have signs indicating the shop floor is off limits to customers
23. Do you have a designated customer waiting area
24. Is premises protected by an electronic alarm system
25. How are customer keys controlled
26. Do you test drive vehicles Yes No
If so, do you have a planned route
Yes
Yes
Yes
Yes
No
No
No
No
27. Are customer vehicles kept overnight Yes No If yes, please indicate: Max # inside Max # outside
28. Is lot Fenced
29. Well-kept documentation of work performed
30. Does shop have Pits
If so, are there procedures in place for verbal double-checking between Pit & Top side workers
31. Any welding on premises
32. Any specialized work for speed or racing preformed
33. Does insured have any affiliation with auto and/or truck racing
34. Describe storage of flammable & combustible liquids.
35. How are waste fluids disposed of & how often
36. Do you use metal containers with self closing lids for oily rags
37. Are there currently serviced, charged & operable fire extinguishers on premises
38. Do you have underground gasoline storage tanks
If yes, please describe
Age of Tanks:
Construction of Tanks:
Describe leak monitoring methods:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
5800 Lombardo Center • Cleveland, OH 44131 216.328.6166 • www.amtrustgroup.com