Application for a Recovery Specialist Quote
(from contracted agents only)
Date: 6/16/2010 Agency Name Producer Name Phone # e-mail address Fax #
Today Date A. GENERAL INFORMATION
1. Applicant’s Legal Name
City County State Zip
3. Proposed Eff Date
4. Legal Entity 5. Years in Business in Current Name
6. Have you owned a similar business or had any change in ownership, management or name of your current
business in the past five years? Yes or No
7. Is your business a subsidiary of another entity or does your business have any subsidiaries? Yes or No
8. Is the owner active in business? Yes or No Owners Name
B. LOSS HISTORY
Valuation Total Term Carrier Premium Reserve Paid Expenses Date
Current: $0.00 st1 Prior: $0.00 nd2 Prior: $0.00 rd3 Prior: $0.00
Total: $0.00 $0.00 $0.00 $0.00
1. Describe all business operations conducted by applicant.
2. Does your business: Y/N % Y/N %
Do Auto Repair Voluntary Repossessions
Do Auto body work Involuntary Repossessions
Towing Other (explain below)
Sell Autos Sell used auto parts
Do Salvage Work Sell used or recapped tires?
Drive Away Operations Transport Company
3. What type of repair or service work is performed?
4. What training have the mechanics or body shop workers received? (Fact. Trained/ Certified)
5. Any cameras or alarms on storage lot? Yes or No
6. Are the storage lots completely fenced and lighted? Yes or No
7. Financial Institutes that you have contracts with: (GMAC, Nations Bank, Bank of America, Other)
8. Total number of vehicle recoveries: Drive-Away Tow -Away
By employees, in the last 12 months:
By independent contractors, in the last 12 months:
Expected in the next 12 months:
9. What kinds of property do you repossess? (check all that apply)
Construction Equip. Tractor/trailer Heavy Equip. Autos Motorcycles Boats ATV’s
Household items: appliances/furniture/electronics/jewelry Other:
10. How many of each do you have issued to your company:
a. Dealer Plates:
b. Transportation Plates:
c. Repossessor Plates:
11. What work do you sub-contract to others?
12. Do you provide or perform services as a sub-contractor to other tow truck operators, recovery agencies,
or other business operations? Yes or No
13. Do you: Y/N
Have a written and enforced policy prohibiting employees from possession of a firearm while at
Have a written and enforced policy for handling a “Hostile Debtor”?
Require the Lending Institution to submit all recovery assignments in writing prior to
performing the recovery?
Have a written company procedure for inventory, storage and releasing of the personal effects
found in the recovered collateral?
Have keys to all automobiles kept in a safe and secure place at all times?
Have a clearly defined boundary and signed business exclusion if any part of the premises is
shared with another business?
Have signs posted prohibiting customers in the work areas?
14. Do you have canine protection?
If Yes – Do you have a written daytime Procedure for the canines?
15. What percentage of your repossessions occur during daylight hours
during night hours
16. Types of towing agreements. Y/N % Y/N % Y/N %
Motor Clubs Dealerships Police
General Public Commercial Other
17. % of trips per year between 0 ? 50 miles 201 ? 500 miles
51 ? 200 miles over 500 miles
1. How many drivers have been employed over 1 year?
2. How many drivers were hired in the last 12 months
3. List Drivers, age and years experience
Driver Age Years Experience in Recovery
Year Make GVW Classification Cost New On Hook Limit On Hook Deductible
F. COVERAGES & LIMITS
Commercial Auto Coverage
Comprehensive Ded Liability Limits
Med Pay Collision Ded
Hired Car Non Owned
Loc 1 Limits Loc 2 Limits
G. PREMIUM Liability General Liab GKLL Property On Hook Risk is currently paying Are Limits same as above Premium you are looking for General Comments