Auto Service, Auto Body Shop

Tailored Coverage for New York Auto Repair, Body, Tire, and Service Shops
Business Name, DBA (Doing Business As)
Address

Street Address

CityState

Zip Code
Contact person
E-mail
Phone Number

Area CodePhone Number

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Payroll & Revenue Estimates

Rows	Annual Sales
Annual gross receipts?

Rows	Dollar Amount
What is the estimated value of your tools and equipment stored inside the shop?

Do you perform painting, refinishing, or spray booth operations on premises?
Do you operate frame machines, lifts, welders, or heavy repair equipment?
Do you subcontract any body, paint, or mechanical work to third parties?
Have you had any Garage Liability, Garagekeepers, Property, Auto, or Workers’ Compensation claims in the past five years?
If yes, please describe the claim
Vehicle Storage & Risk Assessment

Rows	Amount
On average, what’s the value of each customer’s vehicle that you keep on-site?
All together at peak times, what’s the total value of those customer vehicles?

Payroll by Classification

Workers’ Compensation coverage protects your employees in the event of a job-related injury or illness. Accurate payroll by classification ensures proper rating and compliance with New York State WC requirements.

Rows	Annual Payroll
What is the annual payroll for Auto Mechanics and Technicians (NYS WC Code 8380)?
What is the annual payroll for Body Shop and Collision Repair Employees (NYS WC Code 8393)?

Rows Federal ID

What is the EIN Number?

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