tow truck va supp nico rou086 201104
8417 Patterson Avenue Richmond, Virginia 23229 Telephone: (804) 741-7999 WATTS: (800) 628-2967 Fax: (804) 741-9401 www.royaloakunderwriters.com
ROYAL OAK UNDERWRITERS, INC. Excess and Surplus Lines Insurance Wholesalers
Tow Truck Supplement
Policy Term From:
To
This Supplement is a part of the Application and will be relied upon by the Company as an integral part of the Application. IN TOW COVERAGE (To provide coverage on nonowned autos* towed by rollbacks or wreckers) 1)
Limit Per Vehicle $
2)
Number of Scheduled Tow Trucks:
Deductible Per Auto
3)
Are Tractor/Trailer Combinations towed?
4)
Maximum # of Units (Including Trailers) Towed/Hauled by any one Power Unit:
Yes
500
1,000
Other:
No
*If hauling owned units, cargo applies.
STORAGE LOCATION (Specified Causes of Loss and Collision) 1)
Limit of Liability Per Location: $
Deductible Per Auto
2)
Number of Locations:
3)
Maximum Number of Customers’ Autos Stored:
4)
Maximum Limit of any one Covered Auto: $
5)
Are Customers’ cars stored overnight?
6)
Is yard fenced and lighted?
7)
Where are keys to customers’ cars kept?
Yes
Yes
500
1,000
Other:
No
No
AUTO REPOSSESSORS (Only fill out if repossessions are performed) 1)
What % of towing operation involves repossession:
2)
How are vehicles repossessed? Describe procedure in detail.
3)
Are any vehicles driven away?
Yes
No
%
If yes, list # of repo plates and plate number:
List drivers: Is physical damage coverage requested on vehicles driven away? Deductible Per Auto
500
1,000
Yes
No
Limit: $
Other:
4)
Are any independent contractors/subcontractors used?
5)
How many vehicles did you repo last year? By Tow Truck
Yes
6)
Estimate % of repos that are:
No By Drive Away
Private Passenger Autos
%
Light Commercial Trucks
%
Heavy Commercial Trucks
%
Commercial Trailers
%
Subcontractor
Other (Describe) % 100 % 7)
Estimate % of repos that are:
8)
Does applicant or any employees carry firearms?
9)
Are Police notified?
Yes
Voluntary No
% Yes
Involuntary
%
No
Do they ever accompany you on a repossession?
Yes
No
If yes, before or after the fact? 10) List primary customers for which you repossess:
IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES INCLUDE IMPRISONMENT, FINES AND DENIAL OF INSURANCE BENEFITS. Reset Form Submit by E-mail Print Form SAVE rou086-201104
Page 1 of 1
Royal Oak Underwriters, Inc.
ROYAL OAK UNDERWRITERS, INC. Excess and Surplus Lines Insurance Wholesalers
Tow Truck Supplement
Policy Term From:
To
This Supplement is a part of the Application and will be relied upon by the Company as an integral part of the Application. IN TOW COVERAGE (To provide coverage on nonowned autos* towed by rollbacks or wreckers) 1)
Limit Per Vehicle $
2)
Number of Scheduled Tow Trucks:
Deductible Per Auto
3)
Are Tractor/Trailer Combinations towed?
4)
Maximum # of Units (Including Trailers) Towed/Hauled by any one Power Unit:
Yes
500
1,000
Other:
No
*If hauling owned units, cargo applies.
STORAGE LOCATION (Specified Causes of Loss and Collision) 1)
Limit of Liability Per Location: $
Deductible Per Auto
2)
Number of Locations:
3)
Maximum Number of Customers’ Autos Stored:
4)
Maximum Limit of any one Covered Auto: $
5)
Are Customers’ cars stored overnight?
6)
Is yard fenced and lighted?
7)
Where are keys to customers’ cars kept?
Yes
Yes
500
1,000
Other:
No
No
AUTO REPOSSESSORS (Only fill out if repossessions are performed) 1)
What % of towing operation involves repossession:
2)
How are vehicles repossessed? Describe procedure in detail.
3)
Are any vehicles driven away?
Yes
No
%
If yes, list # of repo plates and plate number:
List drivers: Is physical damage coverage requested on vehicles driven away? Deductible Per Auto
500
1,000
Yes
No
Limit: $
Other:
4)
Are any independent contractors/subcontractors used?
5)
How many vehicles did you repo last year? By Tow Truck
Yes
6)
Estimate % of repos that are:
No By Drive Away
Private Passenger Autos
%
Light Commercial Trucks
%
Heavy Commercial Trucks
%
Commercial Trailers
%
Subcontractor
Other (Describe) % 100 % 7)
Estimate % of repos that are:
8)
Does applicant or any employees carry firearms?
9)
Are Police notified?
Yes
Voluntary No
% Yes
Involuntary
%
No
Do they ever accompany you on a repossession?
Yes
No
If yes, before or after the fact? 10) List primary customers for which you repossess:
IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES INCLUDE IMPRISONMENT, FINES AND DENIAL OF INSURANCE BENEFITS. Reset Form Submit by E-mail Print Form SAVE rou086-201104
Page 1 of 1
Royal Oak Underwriters, Inc.
