Repair Shops Insurance Program


Motorcycle Dealerships &
Repair Shops Insurance Program


If you answer the questionnaire thoroughly and if your business fits within the capabilities of our program, we will respond to you within 48 hours.

Name Of Business: 

Your Name: 


   City:  ST:  Zip: 

  Email:  URL: 

  Phone:  FAX: 

    How Many Years Experience: 

             Number Of Owners: 
          Number Of Mechanics: 
Number Of Non-Owner Employees: 

Number of Non-Owner Clerical/ 
       Office/Store Employees: 

  Estimated Annual Payroll 
  For All Non-Owner Employees
  (excluding mechanics):                  

Estimated Annual Gross Sales from:
	           Motorcycle Repair: 

Describe What Your Business Does: 

   How Many Square Feet Does Your Business Occupy: 
   How Many Square Feet Does Your Showroom Occupy: 
How Many Square Feet Does Your Repair Shop Occupy: 

Do You Wish To Insure The Building? Yes No
If So, Show The Limit You Wish Quoted: 

Do You Wish To Insure 
The Computer Equipment In Your Office? Yes No
If So, Show The Limit You Wish Quoted: 
Show The Amount You Wish Quoted (current replacement
cost) On All Other Office Equipment, Inventory &
       Supplies (Other Than Computers and Motorcycles): 
Show the Amount You Wish Quoted on Motorcycles You Own: 
 Average Number of Customer Motorcycles Held Overnight: 
                    Value of Non-Owner Employees' Tools 
                                 (if coverage desired): 

Of What Is The Building Built? Frame	
                               Joisted Masonry
                               Concrete Block
                               Fire Resistive

About What Year Was The Building Built? 

Is there a Restaurant in the building? Yes No
Is Your Building Protected By An 
Indoor Fire Suppression Sprinkler System Yes No
Is There A Fire Alarm? Yes No
Is There A Burglar Alarm? Yes No
Describe Other Security Features
(for example, security bars, guard
dogs, closed circuit TV fencing, etc): 

Does Your Lease Require That 
You Name The Landlord As An Additional Insured? Yes No
Does Your Lease Make You Responsible 
For The Plate Glass Of Your Rental Unit? Yes No
Does Your Lease Make You Responsible For The 
Cost Of Office Build Out Or Tenants Improvements? Yes No
Do You Have Any Corporate Owned Vehicles 
On Which You Wish An Insurance Quotation? Yes No
Do You Have a Tattoo Artist On Premises? Yes No

If Yes, Are They an  Employee Sub-contractor

Do They Carry Liability Insurance? Yes No

If No, Do You Want a Quote? Yes No

Are You a BROS Club Chapter? Yes No

Do You Sponsor "Runs"? Yes No

If So, How Many Per Year? 

In order to quickly respond with your quote, 
we request that all the fields be completed.






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Pasadena, CA 91101-2552

Phone: 800-378-5554 - or - 626-397-4700
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