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Excess Flood Renewal Risk Evaluation
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This form will assist you with assessing excess flood insurance renewal information.
Insured Type?
Is the insured for this excess flood renewal an individual or legal entity?
Individual
Legal Entity (ie. LLC, Corporation, etc.)
Insured 1 First Name
Enter the insured's first name.
Insured 1 Last Name
Enter the insured's last name.
Legal Entity Name?
Enter the name of the legal entity.
Insured's Phone Number
Enter the insured's phone number.
Insured 1 Email
Enter the insured's email.
Property Address
Enter the address of the risk location for this excess flood renewal.
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Residential or Commercial?
Select the property type for this excess flood renewal.
Residential
Commercial
Dwelling Current Replacement Cost?
Enter the building's current replacement cost.
Current Policy Information
Excess Flood Expiration Date
Enter the current expiration date.
MM slash DD slash YYYY
Current Excess Flood Dwelling Limit
Enter the current excess flood dwelling coverage limit.
Current Excess Flood Personal Property Limit
Enter the current excess flood personal property coverage limit.
Dwelling Current Price
Enter the current price for excess flood dwelling coverage.
Personal Property Current Price
Enter the current price for excess flood personal property coverage.
Expiring Policy Taxes and Fees
Enter the expiring policy taxes and fees amount.
Expiring Excess Flood Policy Price
Total expiring premium (Calculates automatically from above figures)
Renewal Quote Information
Renewal Excess Flood Dwelling Limit
Enter the renewal excess flood dwelling coverage limit.
Renewal Excess Flood Personal Property Limit
Enter the renewal excess flood personal property coverage limit.
Dwelling Renewal Quote
Enter the renewal quote for excess flood dwelling coverage.
Personal Property Renewal Quote
Enter the renewal quote for excess flood personal property coverage.
Estimated Taxes and Fees
Enter the estimated taxes and fees for this renewal quote.
Total Renewal Excess Flood Quote
Total quote for this excess flood renewal, including taxes and fees. (Calculates automatically when all previous quote fields are populated.)
Property Risk Profile
Property Flood Zone
Select the flood zone the renewal pricing is based on.
Zone X
Zone B
Zone C
Zone A
Zone AO
Zone AH
Zones A1-A30
Zone AE
Zone A99
Zone AR
Zone AR/AE
Zone AR/AO
Zone AR/A1-A30
Zone AR/A
Zone V
Zone VE
Zones V1-V30
Feet to the Coast/Water
Enter distance to the coast/water in feet.
Elevation Certificate on File?
Is there an elevation certificate on file?
Yes
No
Upload Elevation Certificate
Upload a copy of the elevation certificate.
Max. file size: 128 MB.
Property Elevation
What is the property elevation? (Enter if available)
Excess Flood Risk Mitigation
Select the risk mitigation currently in place at this property. (Select all that apply)
Flood vents
Breakaway walls
Flood barrier/wall
Other Structures
Select the other structures / outbuildings on this property that may have flood risk as well.
Detached garage
Shed
Dock
Pier
Boat house
None
Quote Scenario Center
Excess Flood Renewal Price Difference
Premium difference from the expiring policy to the renewal quote. (Automatically calculates when appropriate fields are populated.)
Excess Flood Coverage Underinsurance
Below is the gap in coverage if the policy is renewed with the renewal dwelling limit listed above. (Calculates automatically)
Suggested Coverage to be Insured to Value
Below is the recommended excess flood coverage limit to ensure the dwelling is insured to value. (Calculates automatically)
Scenario Dwelling Coverage Limit
Enter the desired dwelling coverage limit for this scenario.
Excess Flood Dwelling Coverage Rate
Excess flood dwelling coverage rate per hundred dollars of coverage. (Calculates automatically when appropriate fields are populated.)
Scenario Dwelling Coverage Quote
Quote estimate for excess flood dwelling coverage. (Calculates automatically when desired limit is entered above.)
Scenario Personal Property Coverage Limit
Enter the desired personal property coverage limit for this scenario.
Excess Flood Personal Property Coverage Rate
Excess flood personal property coverage rate per hundred dollars of coverage. (Calculates automatically when appropriate fields are populated.)
Scenario Personal Property Coverage Quote
Estimated quote for personal property coverage. (Calculates automatically when desired personal property limit is entered above.)
Estimated Scenario Taxes and Fees
Enter the estimated taxes and fees amount for this scenario.
Estimated Total Scenario Quote
Estimated total dwelling and personal property coverage quote. (Calculates automatically if previous fields in the scenario section are completed.)
Alternate Limit Quote Request
Would you like us to quote the above scenario for you?
Yes
No
Documents and Comments
Document uploads
Please use this field to upload any relevant insurance documents.
Drop files here or
Select files
Max. file size: 128 MB.
Please enter any additional remarks in the space below.
Please enter any additional remarks in the space below.
Consent
*
Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
I agree
Gates Skene
601-968-0256
https://www.rossandyerger.com/private-client-group
gskene@rossandyerger.com
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