CA License #0699854 Location Supplement for Location 4 and beyond

Applicant:

Section 9: GENERAL LIABILITY: (The Same Limit Applies to ALL locations)

1. Limit: $300,000 $500,000 $750,000 $1,000,000 (Combined Single Limits)

Location : General Liability Section: Please complete the following questions that pertain to the garage operations.

1. Auto Repair and Service Shops (10073) – Mechanical or Body Shop Gross Sales: $

2. Automobile Parts (10071) (New or Incidental Exposures Only) Gross Sales: $

3. Storage Operations (46622) (Include garage area if vehicles are stored inside) Square Footage:

4. Tire Dealers (18616) (Incidental Exposure Only) Gross Sales: $

5. Trucker (99793) (Tower with No Storage Lot or Repair Exposure “Pure Tower”) (Gross Payroll other than drivers): Gross Non Driver Payroll: $

6. Building Not Fully Occupied by the Insured (45539) (Lessor’s Risk Only) Square Footage:

7. Vacant Building (68606) (Other than Not for Profit) Square Footage:

8. Vacant Land (49451) (Other than Not for Profit) Total Acreage:

Additional Exposures:

9. ISO General Liability Code: Description:

Location : General Liability Section: Please complete the following questions that pertain to the garage operations.

1. Auto Repair and Service Shops (10073) – Mechanical or Body Shop Gross Sales: $

2. Automobile Parts (10071) (New or Incidental Exposures Only) Gross Sales: $

3. Storage Operations (46622) (Include garage area if vehicles are stored inside) Square Footage:

4. Tire Dealers (18616) (Incidental Exposure Only) Gross Sales: $

5. Trucker (99793) (Tower with No Storage Lot or Repair Exposure “Pure Tower”) (Gross Payroll other than drivers): Gross Non Driver Payroll: $

6. Building Not Fully Occupied by the Insured (45539) (Lessor’s Risk Only) Square Footage:

7. Vacant Building (68606) (Other than Not for Profit) Square Footage:

8. Vacant Land (49451) (Other than Not for Profit) Total Acreage:

Additional Exposures:

9. ISO General Liability Code: Description:

Location : General Liability Section: Please complete the following questions pertaining to the garage operations.

1. Auto Repair and Service Shops (10073) – Mechanical or Body Shop Gross Sales: $

2. Automobile Parts (10071) (New or Incidental Exposures Only) Gross Sales: $

3. Storage Operations (46622) (Include garage area if vehicles are stored inside) Square Footage:

4. Tire Dealers (18616) (Incidental Exposure Only) Gross Sales: $

5. Trucker (99793) (Tower with No Storage Lot or Repair Exposure “Pure Tower”) (Gross Payroll other than drivers): Gross Non Driver Payroll: $

6. Building Not Fully Occupied by the Insured (45539) (Lessor’s Risk Only) Square Footage:

7. Vacant Building (68606) (Other than Not for Profit) Square Footage:

8. Vacant Land (49451) (Other than Not for Profit) Total Acreage:

Additional Exposures:

9. ISO General Liability Code: Description:

Ed. 6-30-08 Location Supplement Page 1 of 3


CA License #0699854 Location Supplement for Location 4 and beyond

Section 10: Garage Keepers Coverage: Please provide the details of each storage facility.

1. Coverage Type: Legal Liability Direct Primary

Loc. . Limit: $ Address: City: State: Zip:

Loc. . Limit: $ Address: City: State: Zip:

Loc. . Limit: $ Address: City: State: Zip:

Storage Facility: Locations:

Yes No Yes No Yes No

2. Completely fenced

3. Completely lighted at night

4. Surveillance camera equipped

5. Is the facility equipped with Intrusion alarm?

6. Lot attended during business hours

7. ARMED Security guards on duty during the day or at night?

8. Fire extinguishers are accessible at each yard

9. Customers’ keys are kept locked in a secure location

Garage Keepers Operations:

Yes No Yes No Yes No

10. Do you pick up or deliver customers’ vehicles by driving the vehicle itself?

11. Are buildings equipped with sprinkler protection?

12. Do you maintain the proper type and number of fire extinguishers?

13. Do you provide public parking or storage at any of your locations?

Section 15: Salvage, Dismantlers Scrap Metal or Junkyard: Please provide the details of this operation in a narrative presented with the application

Yes No Yes No Yes No

1. Do you have a General Liability Policy in place covering this operation?

2. Do you or have you ever owned or leased a crushing machine?

3. Do you allow third party vendors to perform crushing on your property?

4. Do you allow customers to pull parts from the stored autos?

5. Do you retain a copy of the sales receipt for all parts sold?

6. Does your receipt contain a “Sold as is Warranty”?

7. How many employees do you have involved in this operation?

*** Please provide a SAMPLE COPY of a receipt with the “SOLD AS IS WARRANTY” wording with this application

Section 17: Service Garage / Auto Repairs:

Yes No Yes No Yes No

1. Do you sell auto parts? New Used

2. Do you sell “third party” remanufactured parts?

3. Does your sales receipt contain a “Sold, as is Warranty”

4. Do you sell and install tires? New Used

5. Do you sell recapped tires for private or commercial vehicles?

6. Do you perform any type of welding at any location?

7. Do you have any dogs on your premises during or after hours?

8. Do you have gas sales at any location scheduled on this policy?

9. Are there above ground and/or below ground storage tanks at any location?

10. Do you own or lease out limousines, vans or buses?

11. Do you own or operate a car wash at any location?

12. Do you restrict the public from entering your garage work area?

13. Do you provide an area for customers to wait while their vehicle is repaired?

14. Do you operate a convenience store at any location?

15. Is the facility inspected by a governmental agency on an annual basis?

16. Do you retain written records on all repairs performed by your operation?

17. Are repairs performed on private passenger autos?

18. Are repairs performed on commercial autos or heavy equipment?

19. Do you own, sponsor or work on “race cars”?

20. Are ALL of your service and repair mechanics professionally certified?

21. How many mechanics do you have working at each location?

22. What types of repairs do you perform? Minor Repairs Major Repairs (Rebuild Engines, Transmission)

23. What types of vehicles do you repair Private Passenger Commercial Auto Commercial Equipment

24. How many service bays do you have? How many of those bays have a lift system for hoisting automobiles?

26. Please indicate if you Sell or Service any of the following:

ATV’s Motorcycles Gray Market Vehicles Boats

Kit Cars RV’s Van Conversion Stretch Vehicles

Section 18: Service Garage / Auto Body Shop: Yes No Yes No Yes No

1. Do you have a paint booth?

2. Do you have a UL approved Paint Booth?

3. Do you paint cars outside of the booth?

4. Do you perform welding as part of the repair?

5. Do you have a frame-straightening machine?

6. How many employees do you have involved in this operation?

7. What company manufactured the Frame Straightening Machine?

Ed. 6-30-08 Location Supplement Page 1 of 3