Page 4 of 4 national producer number required in.
Acord garage keepers application.
He she represents that the answers are true correct and complete to the best of his her knowledge.
Service or repair shops coverages limits use acord 138 for your state to provide coverages limits information non dealers premises operations.
Enter the number of autos located on the premises.
Acord 128 2014 12 the undersigned is an authorized representative of the applicant and represents that reasonable inquiry has been made to obtain the answers to questions on this application.
I understand that the coverage selection and limit choices indicated here or in any state supplement will apply to all.
I have made my selection on this application and i have read and completed the umpd portion of the california auto supplement acord 61 ca.
The acord name.
This form has been designed to handle the basic underwriting needs for automobile service operations and automobile dealers space is provided to enter driver information for up to eight drivers.
Endorsements remarks acord 101 additional remarks schedule may be attached if more space is required effective date named insured s policy number carrier naic code agency page 1 of 2 agency customer id.
Enter the liability limit sum of all autos being covered per each location.
Acknowledge that i have been offered personal injury protection no fault coverage options in the supplement to this application acord 62 fl.
The location number for the garage keepers coverages should correspond to a location number documented on the acord 125.
Garage keepers enter the limit for each location of autos ded per loss.
Garage and dealers section the following provides the user with basic instructions for completing acord 128 garage dealers section.
Acord 0138 ca garage and dealers 2016 02.
Enter the limits for each location.
Include the fire district name and code if fire or comp otc coverage is provided in physical damage or garage keepers above endorsements remarks acord 101 additional remarks schedule may be attached if more space is required effective date named insured s policy number carrier naic code agency agency customer id.
Texas garage and dealers date mm dd yyyy coverages limits section the acord name and logo are registered marks of acord.
Date mm dd yyyy annual gross sales number of gallons of gas pumped per year.
Attach to acord 128 applicant s signature date producer s signature national producer number coverages limits section other collision 30 legal liability direct basis primary excess loc deductible per auto maximum garage keepers enter the limit for each location of autos ded per loss perils 30 specified comp.
