TMR Insurance Quote Form

1

First and Last Name of Person Submitting Application* This field is required.

First Name

Last Name

2

Email* This field is required.Enter the email that your quote will be sent to

example@example.com

3

State of Dealer LicensePlease enter the state that issued or will issue your dealer license

4

Full Legal Business Name* This field is required.Be sure to enter LLC, or CORP, or INC if applicable

5

Location # 1 Address* This field is required.Be sure to enter the entire address with zip code, no PO boxes please

6

Additional Location Address (if any)Only enter if you will have multiple locations.

7

Description of Operations* This field is required.Please give a detailed description of your operations and whether you will be a retail dealer, or wholesale dealer, or broker

8

Do you perform any repairs, if so, please explain* This field is required.Please be advised this policy covers used dealers, not repair shops. Repair shops would need a separate Garage Keepers insurance policy that is not included in this quote submission

9

Type of vehicles you sell or will sell and percentage* This field is required.For example, 80% used cars 20% used motorcycles

10

Years in business* This field is required.If new operations, just enter 0

11

Years of experience in used car industry* This field is required.If new operations, just enter 0

12

Pickup/delivery radius* This field is required.Your pickup and delivery radius is where you operate, such as the maximum distance you will drive to and from a dealer auction. The smaller radius you operate in, the lower the insurance premium

0-300 miles

301-500 miles

501 to unlimited miles

13

Do you use contract drivers to transport vehicles?* This field is required.A contract driver is someone other than you that may transport vehicles to and from auctions. This policy will allow up to two owners at no additional increase in premium. Each contract driver that is not an owner may raise premiums

YESNO

14

Current insurance carrier* This field is required.If currently licensed, enter current carrier, if obtaining license for the first time, enter "new operations"

15

Renewal date* This field is required.If currently licensed, enter renewal date, if obtaining license for first time, enter "new operations"

16

If no current carrier, when was the last time you held coverage for your business?* This field is required.Be sure to explain why your coverage has lapsed, or enter "new operations"

17

Any losses in the past three years (Y/N)? If yes, please explain:* This field is required.If obtaining license for first time, just enter "no losses"

18

Combined Single Limit Requested* This field is required.If you have a $300,000 Combined Single Limit policy and cause an accident that injures three people and damages the other vehicle, your insurance will pay up to $300,000 for ALL damages, regardless of how the damages are distributed

Minimum required by my state's law

$150,000

$200,000

$250,000

$300,000

19

Uninsured/Underinsured Motorists Requested (Y/N)* This field is required.Pays when an accident is caused by an uninsured or underinsured motorist. May increase premium

YESNO

20

Personal Injury Protection Requested (Y/N)* This field is required.No-fault coverage that pays medical bills and lost wages for the driver and passengers after an accident — regardless of who caused it. May increase premium

YESNO

21

Medical Payments Requested (Y/N)* This field is required.Pays medical expenses for the driver and passengers after an accident, regardless of fault — but only pays medical bills not lost wages. May increase premium

YESNO

22

Broadened Coverage Requested (Y /N)* This field is required.Optional endorsements that include two components: Personal Injury & Advertising Injury Coverage and Fire Legal Liability. May increase premium

YESNO

23

Additional Insured (Y/N)* This field is required.A person or business added to your insurance policy who receives liability protection under your coverage — typically a lender, landlord, or partner connected to the dealership. May increase premium

YESNO

24

Dealers Open Lot Aggregate Limit Requested* This field is required.The maximum amount the insurance company will pay for all covered losses over ALL locations within one policy period. The maximum aggregate limit is $300,000. Example: If your inventory has a wholesale value of $100,000 then you should have at least $100,000 of Dealers Open Lot coverage

25

Dealers Open Lot Per Occurrence Limit* This field is required.The maximum amount the insurance company will pay for a single loss over all locations. The maximum per occurrence limit offered is $300,000. The per occurrence limit cannot exceed the aggregate limit. Although it is your choice, most dealers choose a Per Occurrence Limit that is the same amount as the Aggregate Limit

26

Dealers Open Lot Per Covered Auto or Per Unit Limit* This field is required.The maximum amount the insurance company will pay for one vehicle. The maximum amount per covered auto is $50,000. This limit cannot exceed the maximum per occurrence.

27

Average Value Per Vehicle to be Sold* This field is required.Enter the average value of each vehicle you intend to sell. Try to be as accurate as possible, although you may change this figure in the future.

28

Current Number of Vehicles Held* This field is required.Enter the current number of vehicles you hold for resale. If obtaining license for the first time, enter "new operations"

29

Maximum Number of Vehicles Held* This field is required.Enter the maximum number of vehicles that you have or will hold for resale. If obtaining license for the first time, enter your most accurate estimate.

30

Are cars examined for pre-existing damage?* This field is required.Examining vehicles for pre-existing damage can lower insurance premiums. Be sure to be truthful and honest on all questions

YESNO

31

Are unaccompanied test drivers allowed?* This field is required.If you allow your customers to test drive vehicles without you or an employee in the vehicle, you will need an "Unaccompanied Test Driver Endorsement" which can be purchased at an additional premium of $250. If the "Unaccompanied Test Driver Endorsement" is not purchased, then you or an employee must accompany your customers on all test drives

YESNO

32

Property type (check all that apply):* This field is required.An enclosed building and open lot are most common

Enclosed building

Open lot

Covered parking

Broker office only

Other

35

Do you have an alarm system?* This field is required.

YESNO

36

If you have an alarm system, is it monitored or on site only,?* This field is required.

Monitored

On site only

No alarm system

37

Where are keys kept after hours?* This field is required.Keys and fobs must be kept in a secure location, such as safe, locked file cabinet, or locked desk. Be sure to be truthful and honest on all questions

38

Any additional security enhancements?* This field is required.

YESNO

39

If you have additional security enhancements, check all that apply* This field is required.

Lights

Watchman

Dogs

Dealer plates locked & secured

Wheel locks installed

Video Surveillance

Other

40

First and Last Name* This field is required.

First Name

Last Name

41

Date of Birth* This field is required.

Date

42

Driver License Number* This field is required.

43

State* This field is required.Enter state of driver license

44

Auto Furnished Driver?* This field is required.Auto Furnished Driver-a person listed on the policy who can use the dealer’s vehicles for both business and personal use. This means the listed driver can take any vehicle in the dealer’s inventory and drive it home, to the store, etc. just like having a personal vehicle. Common for an owner. Providing employees a furnished auto may dramatically increase your premium

YESNO

45

Is this driver an employee?* This field is required.An owner is not considered an employee

YESNO

46

Job title or relationship to insured.* This field is required.Enter "owner" if you are the owner (insured), otherwise enter the job title of the employee or the relationship to the insured. (Please be advised some states strictly prohibit family members that are not affiliated with the dealership to drive vehicles with a dealer license plate.)

47

Second Driver First and Last NameJust leave blank if there is not second driver on the policy

First Name

Last Name

48

Second Driver Date of BirthJust leave blank if there is not second driver on the policy

Date

49

Second Driver's Driver License NumberJust leave blank if there is not second driver on the policy

50

Second Driver StateJust leave blank if there is not second driver on the policy

51

Second Driver Auto Furnished Driver?Just check no if there is not second driver on the policy. Auto Furnished Driver is a person listed on the policy who can use the dealer’s vehicles for both business and personal use. This means the listed driver can take any vehicle in the dealer’s inventory and drive it home, to the store, etc. just like having a personal vehicle. The is common for an owner. Providing employees a furnished auto may dramatically increase your premium

YESNO

52

Is the second driver an employee?An owner is not considered an employee

YESNO

53

Job title or relationship Second Driver to insured.Just leave blank if there is not second driver on the policy

54

Enter year, make, and model of all "Scheduled Autos" List all tow trucks, wreckers, car haulers, car carriers, or other vehicles used primarily for towing or transporting dealer's own vehicles. If no scheduled autos, please enter "No Scheduled Autos"

55

RemarksPlease enter any remarks or any other information you would like to share with the underwriter.