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Flood Insurance Quote
Personal Information
Name (First and Last)
Phone
Email
Property Address
Lenders Requirement
Yes
No
Loan Closing
Yes
No
Existing Flood Insurance
Yes
No
Property purchased on or after 7/6/2012?
Yes
No
Property Purchase Date
Building Type
Single Family Dwelling
2-4 Family Dwelling
Condominium
Other Residential
Non-Residential
Mobile Home
Modular Home
Building Purpose
100% Residential
100% Non-Residential
Mixed Use
Date of Construction
Number of Floors
Severe Repetitive Loss Property
Yes
No
Garage
Attached
Detached
Is building in course of construction?
Yes
No
Second Home
Yes
No
Occupancy
Principal/Primary
Tenant occupied
Rental Property?
Yes
No
Foundation
Slab
Crawlspace
Basement
Has the building been substantially improved more than 50% of market value at one time?
Yes
No
Replacement Cost
Any flood claims or flood losses
Yes
No
Building Coverage Amounts:
Contents Coverage Amount
Residential Deductible
$1,000
$2,000
$3,000
$4,000
$5,000
$10,000
Commericial Deductible
$1,000-$5,000
$10,000
$15,000
$25,000
$50,000
SECTION 1 ALL BUILDINGS
Site Location
Approximate distance of site location nearest shoreline
Less than 200 feet
200 to 500 feet
500 to 1000 feet
Over 1000 feet
Source of Flooding
Ocean
Lake
River or Stream
Other
Is this building located over water?
No
Yes, Fully
Yes, Partially
Garage
Is the garage attached to the building?
Yes
No
Square Footage of Garage
Are there any openings or breakout panels (excluding doors) that are designed to allow the passage of flood waters into the garage?
Yes
No
Number of Vents
Size of each Vent
Vents within 1 foot of ground (not to exceed 1 Ft.)
Yes
No
Is the garage finished having more than 20 linear feet of finished wall or paneling?
Yes
No
Is the garage solely used for parking of vehicles, building access or storage?
Yes
No
Items In the Garage
Furnace
Hot water heater
Heat pump
Air Conditioning
Elevator or equipment
Oil tank Cistern
Is Machinery/Equipment elevated above the slab?
Yes
No
If yes, how high
Foundation of the Garage
Piers, posts, or piles
Reinforced mansonry pieces or concrete piers or columns
Reinforced concrete shear walls
Solid perimeter walls
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