Heavy Vehicle & Equipment Questionnaire Template
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1
2HEAVY VEHICLE & EQUIPMENT QUESTIONNAIRE
Dependent upon state authority, you are applying for insurance coverage provided by and underwritten by one of
the following insurance companies of ARGO GROUP US:
ARGONAUT-MIDWEST INSURANCE COMPANY
COLONY SPECIALTY INSURANCE COMPANY
ARGONAUT INSURANCE COMPANY
COLONY INSURANCE COMPANY
This Questionnaire is supplemental to and part of the Colony Specialty Garage Application (G1000) or the Colony
Specialty Garage Renewal Application (G1001).
Business Trade Name: _______________________________________________________________________
1. What percentage of applicant’s operations involve:
Boom Trucks/Bucket Trucks
______ %
Logging Trucks/Equipment ________ %
Buses
______ %
Military Vehicles
________ %
Construction Equipment
______ %
Mining Equipment *
________ %
Municipal Vehicles
______ %
Oilfield Equipment *
________ %
Cranes
______ %
Refrigerated Vans/Trailers
________ %
Farm Equipment
______ %
Semi-Trailers
________ %
Farm Implements
______ %
Tank Trailers/Tankers
________ %
Forklifts
______ %
Truck Tractors
________ %
Lawn/Tree Service Equipment
______ %
Other *
________ %
* Describe: ___________________________________________________________________________
2. Where are applicant’s operations performed?
Your Shop
______ %
Customer’s Yard
______ %
Truck & Travel Center
______ %
Roadside
______ %
3. What percentage of applicant’s work is:
Body & Paint
______ %
Blades/Cutting Equip/Chippers
______ %
Brakes
______ %
Brakes - Logging truck/Equipment
______ %
Engine Overhaul
______ %
Fabrication
______ % Answer Question 7
FMCSA Safety Inspection
______ % Answer Question 8
Hydraulics - General
______ %
Hydraulics – Lifting apparatus
______ %
Lube & Oil
______ %
Power Train
______ %
Radiator
______ %
Refrigeration Unit (Cargo Area)
______ %
Repair Tank Trlrs (External)
______ %
Snowplow Repair/Installation
______ % GVW of Vehicles: ______________
Subcontracted out to others
______ %
Structural/Frame Modifications
______ % Do you cut frames between the axles?
Yes
No
Suspension/Frame Repairs
______ %
Suspension - Logging truck/Equipment ______ %
Tank Clean/Repair - Internal
______ %
Tank Repair - External
______ %
Tire Repair or Replacement
______ %
G1008-0715
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Parent category: Life