Renewal – Flood Risk – RiskRevu.com

Flood Risk Evaluation

This form will help identify aspects of your property/insurance coverages that we can discuss as they relate to protecting you from flood damage.

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Full name

What is your full name?

First name*

What is your first name?

Last name*

What is your last name?

What is your preferred phone number?

What is your email address?

What is the address of the property you would like to discuss Flood insurance for?

Street Address Address Line 2 City State ZIP Code

Flood?

Do you have a flood policy in place today?

Yes
No

Excess flood?

Do you have an excess flood policy in place today? (Excess flood insurance provides additional coverage limits above those provided by a primary flood policy.)

Yes
No
Unsure

Elevation certificate

Do you have an elevation certificate for your property?

Yes
No
Unsure

Please upload your elevation certificate so we can review it.

Max. file size: 128 MB.

Flood mitigation

Please select the risk mitigation strategies you have at this property to help prevent flood damage.

Flood vents
Elevated home
Elevated machinery
Back flow stoppers
None
Other

What other risk mitigation strategies do you have a this property to help prevent flood damage?

Renovations

Have you done any renovations or are you planning any renovations?

Yes
No

Describe renovations

Please tell us about the renovations.

Occupancy

What is the occupancy of the home we are discussing flood coverage for?

Primary home
Vacation home
Rental property
Unoccupied - still furnished
Vacant - not furnished

Trust or LLC

Is this property owned by a trust, LLC or other entity?

Yes
No

Please tell us the legal name of the trust, LLC or other entity that owns this property.

Mortgage

Did you pay off a mortgage recently?

Yes
No

Outbuildings

Are there any outbuildings (fence, detached garage, shed) you would like to discuss flood coverage for?

Yes
No

Please tell us about the outbuildings you have at this location?

Does this property have a finished basement?

Yes
No
Partially finished

Valuables

Do you have art, jewelry or antiques that you would like to obtain flood coverage for?

Yes
No

Describe valuables

Please describe the valuable articles you would like to obtain flood coverage for.

Anything else?

Is there anything else you would like to discuss regarding flood insurance with us?

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

Flood Risk Evaluation

Flood Risk Evaluation

Kurt Thoennessen, CAPI

RiskRevu^TM Newsletter

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Flood Risk Evaluation

Flood Risk Evaluation

Kurt Thoennessen, CAPI

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RiskRevu^TM Newsletter