Automobile Vehicle Inspection Form Page 2
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2
3Tires (power unit or trailer):
Condition:
New
Used
Retreads; # of retreads_______
Tread Depth:
Good 8/32 to 7/32
Fair 6/32 to 5/32
Poor 4/32 or less
Comments (required if retreads or the tread depth is fair or poor):
_________________________________________________________________________________________________
____________________________________________________________________________
Overall mechanical condition of the vehicle:
Excellent
Good
Fair
Poor
Comments (required if mechanical condition is Fair or Poor):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Vehicle Alterations:
Yes
No
Comments (required if answer is Yes):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
General Appearance of Vehicle:
Excellent
Good
Fair
Poor
Comments (required if appearance is Fair or Poor):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Important Note to insured: All necessary repairs must be completed within 30 days of the inspection or a
written explanation must be provided to your insurance carrier giving the reason for any delay to the repair of
the vehicle. A copy of the repair receipt or invoice must be provided to your insurance carrier within 30 days
of the repair to the vehicle. Failure to comply with these conditions may result in cancellation of your
insurance policy.
Inspection Facility:
By signing this inspection form you certify that you are an independent mechanic and not an employee of the
insured. You further verify that the answers and statements provided in this form are a result of your physical
inspection of the vehicle identified in the Vehicle Description section and are correct to the best of your
knowledge.
__________________
____________________________________
_______________________
Name of Garage
Address
State Inspection # (if applicable)
______________________
____________________________________________
____________________________
Date Inspected
Name of Inspecting Mechanic (please print)
Signature of Mechanic or Proprietor
Vehicle Inspection (Ed. 6/11)
Page 2
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