GARAGE VEHICLE CERTIFICATE APPLICATION
The certificate, hereinafter called the Garage Policy or the policy, is issued on the basis
of the information contained herein. This application forms part of the policy.
ICBC USE ONLY
420 NEW
450 RENEW
ICBC USE ONLY
EFFECTIVE DATE (ddmmyyyy)
EXPIRY DATE (ddmmyyyy)
PREVIOUS POLICY NUMBER
INDICATE HERE THE LEGAL
ENTITY TO BE INSURED BY
THIS POLICY, E.G. INDIVIDUAL,
COMPANY, SOCIETY, ETC.
4
PROVINCE
CITY / TOWN
POSTAL CODE
PROVINCE
200
AUTO TOWING
401
AUTO CONVERSION (OR 603)
700
SERVICE STATION (OR 604)
902
AUTO TRANSPORTER
300
NEW & USED AUTO DEALER
402
SCHOOL VOCATIONAL AUTO SHOP
701
AUTO CLEANING
903
BAILIFF (OR 606)
301
MOTORCYCLE DEALER
403
PRIVATE REPAIR GARAGE
702
AUTO GLASS INSTALLATION
302
AUTO WHOLESALER (OR 601)
500
IMPLEMENT DEALER
800
RECREATIONAL VEHICLE DEALER
303
TRUCK DEALER (OR 608)
501
EQUIPMENT DEALER
801
BOAT TRAILER DEALER
400
REPAIR GARAGE (OR 602)
600
USED AUTO DEALER
900
AUTO PARKING
NOTE: INDICATE ALL ASPECTS OF INSURED’S
BUSINESS AND CIRCLE
PRINCIPAL OPERATION
TOTAL NUMBER OF EMPLOYEES (PART TIME EMPLOYEES COUNT THE SAME AS FULL TIME EMPLOYEES) – NB.100% FORFEITURE CLAUSE APPLIES [SECTION 75 INSURANCE (VEHICLE) ACT.]
DESCRIPTION
NUMBER
A
PROPRIETORS, PARTNERS, OFFICERS, MANAGERS, AND SALESPERSONS; PLUS ALL EMPLOYEES WHOSE DUTIES CONSIST PRINCIPALLY OF THE OPERATION OF VEHICLES.
B
CLERICAL OFFICE EMPLOYEES INCLUDING SELF SERVICE CASHIERS.
C
ALL OTHER EMPLOYEES NOT IN CLASS (A) OR (B) (E.G. MECHANICS, BODY SHOP AND PARTS PEOPLE, ETC.)
5
DO YOU HAVE AN AUTOPLAN FLEET?
6
1. IS THIS A NEW BUSINESS OR A NEW LOCATION?
YES
NO
2. IS THERE A CHANGE IN PROTECTION (AGAINST FIRE,
THEFT OR VANDALISM) AT AN EXISTING LOCATION?
YES
NO
YES
NO
IF “YES”, ENTER FLEET NO.
IF ANSWER IS YES TO EITHER QUESTION,
ATTACH A PHOTOGRAPH OF THE NEW OR
EXISTING LOCATION WHICH VISUALLY DESCRIBES
THE BUSINESS AND PROTECTION IF ANY.
8A
COVERAGES REQUIRED
1. THIRD PARTY LIABILITY LIMIT
INDICATE
NUMBER OF
EMPLOYEES IN
EACH CLASS.
Under section 75 of the Insurance (Vehicle)
Act, your claim is invalid if at any time you fail
to provide complete and accurate information,
violate a term or condition of your policy or
commit fraud. This is a summary. For full
information, see section 75 of the Insurance
(Vehicle) Act.
TOTAL NUMBER & TYPE OF PLATES REQUIRED WITH THIS POLICY
N.B. 100% FORFEITURE CLAUSE APPLIES [SECTION 75 INSURANCE (VEHICLE) ACT].
$
NUMBER
2. OWNED VEHICLES - 80% COINSURANCE CLAUSE APPLIES (SEE RIDER APV 4E)
COLLISION
$
DEDUCTIBLE
DEMONSTRATION PLATES (EXCLUDING M/C & TRAILER DEMOS)
COMPREHENSIVE
$
DEDUCTIBLE
REPAIRER’S PLATES (SEE 8B)
OR SPECIFIED PERILS
$
DEDUCTIBLE
TRANSPORTER PLATES
OR SPECIFIED PERILS EXCLUDING THEFT
$
DEDUCTIBLE
PRIVATE PASSENGER PLATES
COMMERCIAL PLATES (5000 KG GVW OR LESS)
3. CUSTOMERS’ VEHICLES - 90% COINSURANCE CLAUSE APPLIES
COLLISION
$
DEDUCTIBLE
COMMERCIAL PLATES (OVER 5000 KG GVW)
COMPREHENSIVE
YES
NO
TRAILER PLATES (INCL. TRAILER DEMO PLATES)
OR SPECIFIED PERILS
YES
NO
MOTORCYCLE PLATES (INCL. M/C DEMO PLATES)
TOTAL VALUE OF CUSTOMERS’ VEHICLES
AT ALL LOCATIONS
8B
POSTAL CODE
THE VEHICLES IN RESPECT OF WHICH INSURANCE IS TO BE PROVIDED ARE THOSE USED IN CONNECTION WITH THE INSURED’S BUSINESS OF:
CLASS
7
IF MORE THAN ONE LOCATION
ATTACH LIST OF ADDRESSES.
ADDRESS WHERE BUSINESS IS LOCATED IF DIFFERENT FROM MAILING ADDRESS
MAILING ADDRESS OF INSURED
CITY / TOWN
3
POLICY NUMBER
APV4A
NAME OF INSURED (SURNAME FOLLOWED BY GIVEN NAMES)
2
FLEET I.D. NUMBER
TOTAL NUMBER OF LICENCE PLATES
0
$
IF REPAIRER’S PLATES ARE REQUESTED, DESCRIBE BRIEFLY WHAT VEHICLES THEY WILL BE USED FOR. (E.G. USED ON OWNED UNLICENCED VEHICLES OR CUSTOMER’S UNLICENCED VEHICLES, OR USED TO OPERATE
UNLICENCED LOGGING TRUCKS)
ABOVE DESCRIBED VEHICLES ARE OWNED BY (NAME OF CUSTOMER)
APV4A (072013)
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9
REFER TO AUTOPLAN MANUAL VOLUME 3, GARAGE SECTION, FORM COMPLETION, BEFORE COMPLETING THIS SECTION.
DO YOU HAVE A NEW VEHICLE FRANCHISE? (IF YES, INDICATE MAKE AND/OR WHOLESALER)
YES
10
NO
LOCATION OF OWNED VEHICLES
– COMPLETE ONE BOX (A), (B) OR (C) FOR EACH AREA WHERE VEHICLES ARE STORED, EVEN IF ADDRESS OF STORAGE AREA IS THE SAME.
– ATTACH SEPARATE LIST IF VEHICLES ARE STORED IN MORE THAN 3 AREAS.
10A
LOC. 1
ADDRESS:
AN EXAMPLE OF PROTECTIONS FOR A BUILDING:
INDICATE WITH AN “X” IF STORAGE AREA IS (COMPLETE ONE BOX ONLY):
A BUILDING
A FULLY ENCLOSED COMPOUND
“CONCRETE ONE STOREY BUILDING WITH A SPRINKLER SYSTEM AND A LOCAL ALARM”.
AN OPEN LOT
DESCRIBE THE PROTECTION FOR FIRE, THEFT AND VANDALISM WHICH IS PROVIDED AT THIS STORAGE AREA:
NEW VEHICLE STOCK
USED VEHICLE STOCK
PLATED VEHICLES
(EG. DEMONSTRATORS AND SERVICE VEHICLES)
INDICATE THE VALUE OF OWNED VEHICLES KEPT AT THE ABOVE STORAGE AREA FOR EACH OF THE FOLLOWING CATEGORIES:
(N.B. 80% COINSURANCE CLAUSE APPLIES) – SEE RIDER APV 4E
10 B
LOC. 2
$
$
$
ADDRESS:
INDICATE WITH AN “X” IF STORAGE AREA IS (COMPLETE ONE BOX ONLY):
A BUILDING
A FULLY ENCLOSED COMPOUND
AN EXAMPLE OF PROTECTIONS FOR AN OPEN LOT:
AN OPEN LOT
“6 FT CHAIN LINK FENCE ONE SIDE AND REAR, 8” CURBS IN FRONT, DITCH ON ONE SIDE
WITHOUT FENCE, USES BLOCKER CARS AT NIGHT”.
DESCRIBE THE PROTECTION FOR FIRE, THEFT AND VANDALISM WHICH IS PROVIDED AT THIS STORAGE AREA:
NEW VEHICLE STOCK
USED VEHICLE STOCK
PLATED VEHICLES
(EG. DEMONSTRATORS AND SERVICE VEHICLES)
INDICATE THE VALUE OF OWNED VEHICLES KEPT AT THE ABOVE STORAGE AREA FOR EACH OF THE FOLLOWING CATEGORIES:
(N.B. 80% COINSURANCE CLAUSE APPLIES) – SEE RIDER APV 4E
10 C
LOC. 3
$
$
$
ADDRESS:
INDICATE WITH AN “X” IF STORAGE AREA IS (COMPLETE ONE BOX ONLY):
A BUILDING
A FULLY ENCLOSED COMPOUND
AN EXAMPLE OF PROTECTIONS FOR A FULLY FENCED COMPOUND:
“8FT CHAIN LINK FENCE WITH 3 STRANDS OF BARBED WIRE ON TOP, TRAINED GUARD DOG,
FLOOD LIGHTS ALL NIGHT. FREQUENT POLICE PATROLS”.
AN OPEN LOT
DESCRIBE THE PROTECTION FOR FIRE, THEFT AND VANDALISM WHICH IS PROVIDED AT THIS STORAGE AREA:
NEW VEHICLE STOCK
USED VEHICLE STOCK
PLATED VEHICLES
(EG. DEMONSTRATORS AND SERVICE VEHICLES)
INDICATE THE VALUE OF OWNED VEHICLES KEPT AT THE ABOVE STORAGE AREA FOR EACH OF THE FOLLOWING CATEGORIES:
(N.B. 80% COINSURANCE CLAUSE APPLIES) – SEE RIDER APV 4E
11
$
$
$
FLOOR PLAN – LIENHOLDER
1. DO YOU HAVE VEHICLES FINANCED AND INSURED ON A FLOOR PLAN?
YES
VALUE OF EXCLUDED FLOOR
PLAN STOCK
NO
2. IF “YES” WHO FINANCES THE FLOOR PLAN?
$
2. IF “YES” WHO INSURES THE FLOOR PLAN?
NOTE: ALL VEHICLES FINANCED AND INSURED UNDER A FLOOR PLAN WILL BE EXCLUDED FROM COMPREHENSIVE AND SPECIFIED PERILS COVERAGE BY THE FLOOR PLAN EXCLUSION ENDORSEMENT (APV 4AA)
3. PROVIDE THE NAME AND ADDRESS OF LIENHOLDER (IF APPLICABLE)
3. PROVIDE THE NAME AND ADDRESS OF LIENHOLDER (IF APPLIC
12
ENDORSEMENTS REQUESTED
NAMED VEHICLE ENDORSEMENT (APV4H)
13
NAME:
ADDRESS:
DETAILS OF LOSSES:
YES
NO
IF YES, VEHICLE TYPE
CONSEQUENTIAL LOSS CUSTOMERS’ VEHICLES (APV4P)
YES
NO
IF PREVIOUSLY INSURED WITH OTHER THAN I.C.B.C., PROVIDE THE FOLLOWING:
A. NAME OF PREVIOUS INSURANCE COMPANY
B. POLICY NO.
C. ATTACH SEPARATE LIST PROVIDING DETAILS OF LOSSES INCLUDING DATES, KIND OF LOSS, AMOUNTS PAID AND AMOUNTS OUTSTANDING.
IF PREVIOUSLY INSURED WITH I.C.B.C., PROVIDE POLICY NUMBER
14
AGENT’S COMMENTS ( E.G. TOW UNIT PLATE NUMBER, OR LEGAL ENTITY NUMBER. ATTACH MEMO IF NECESSARY )
By signing below, the applicant declares that the foregoing particulars are true, and acknowledges and understands that the Motor Vehicle Liability Insurance Card
Canada Inter-Province on the back of this Garage Vehicle Certificate Application is not valid.
APPLICANT’S SIGNATURE (IF APPLICANT IS A COMPANY – SIGNATURE OF OFFICER AND TITLE)
AGENT NAME (PRODUCER)
APV4A (072013)
TELEPHONE NUMBER
AGENT I.D. NUMBER
AGENT TELEPHONE NUMBER
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Some Important Points About Garage Vehicle Certificate Applications
1. Number of Employees (Section 4)
It is important that the applicant accurately states the number of persons employed. Failure to do so, means that the
applicant’s rights to insurance money are forfeited.
2. Value of Customers' Vehicles (Section 7)
It is important that the applicant realistically estimates the maximum value of customers' vehicles that may be in the
applicant's care, custody and control at any given time. Note that a 90% coinsurance clause applies here.
3. Demonstration/Repairer's/Transporter's Plates (Section 8A)
These plates can only be issued to those garage operators who are authorized to use them. (See Floater Licences,
Fees and Premiums — Volume 3.)
4. Value of Applicant's Vehicles (Section 10)
It is important that the applicant accurately indicates the maximum value of applicant owned vehicles stored at all
locations where the applicant's business is conducted. Note that an 80% coinsurance clause applies here.
5. Photograph of Applicant's Premises (Section 6)
It is important that this photograph provides a clear visual description of the risk being insured.
6. Protections (Section 10)
Describe how the stock of vehicles is protected from theft, fire and vandalism. Photographs and diagrams are helpful.
Discounts in rates are available for protections.
7. Legal Entity (Section 2)
It is essential that the policy be issued to a documentable legal entity. (See Issuing Information — Volume 3.)
8. Completion of the Application
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If the applicant is seeking coverage solely for vehicles owned by customers, only Sections 1–7 and 12–15 need to be
completed. All sections should be completed if the applicant is seeking coverage for both customer-owned and selfowned vehicles.