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Business Flood Quote Request
Your Information
Last Name
*
First Name
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Email Address
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Street Address
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City
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State
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Zip Code
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Phone Number
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Alternate Phone
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Business Information
Company Name
Company Street Address
City
State
Zip Code
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Building & Property Information
Building & Property Information
Occupancy Type
Owner
Tenant
Vacant
Ownar and Tenant
Building Type
House
Condo-Contents
Townhome
Apartment Building
Office Building
Condo Assoc Complex
High Rise Building
Manufacturing Building
Year Built
Flood Map Zone Number
Total square footage of the building your business is in
What date was the property purchased?
Total square footage of the customer area only
Garage Description
No Carport-Garage
Carport Attached
Carport detached
Garage Attached
Garage detached
Tuck Under Parking
Above Ground Parking
Below Ground Parking
Parking Lot
Street Parking
How many stories is it?
If two stories, what is the ground floor square footage?
What is the construction type?
Frame
Brick
Stone
Masonry
Superior
Log Cabin
Frame-Stucco
Masonry Veneer
What is the foundation type?
Flat Slab-Poured Reinforced Concrete
Piers
Wood
Stilts
Posts and Pilings
Basement
Masonry
Rubble Stone
Non-Reinforced Concrete
Crawl Space-Concrete Perimeter
Crawl Space-Wood Perimeter
What is the nature of sub-soil?
Sand
Clay
Rock
Marsch
Filled Land
Unconsolidated Ground
Natural Consolidated Ground
What is the topography?
Flat
Cliff
Terraced
Steep Hill
Gentle Hillside
Under 100ft to Water
Hillsidw Over 30 Degrees
Is there any erosion in the area?
What type of roof covering?
Was the roof updated?
Yes
No
If yes, what year?
What is the distance to fire protection?
1000 ft or less to hydrant and 5 mi or less to fire station
Over 1000 ft to hydrant and 5 mi or less to fire station
Between 5 and miles to fire station
Over 10 miles to fire station
Is the business in a brush area?
Yes
No
If yes, has the brush been cleared by 250 feet from all around the building?
Yes
No
Is there any below ground parking?
Yes
No
Is there any soft first story or tuck under parking?
Yes
No
Are there smoke detectors at this location?
Yes
No
Is there a fire extinguisher?
Yes
No
Is the electrical updated?
Yes
No
Are there circuit breakers?
Yes
No
Is the heating / air conditioning thermostatically controlled?
Yes
No
Is the heating/ air conditioning central?
Has the plumbing been updated?
Yes
No
If yes, what year was the plumbing updated?
Does the building have interior automatic fire sprinklers?
Yes
No
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Claim & Coverage Information
Claim Information
Were there any losses or claims in the last 5 years?
Yes
No
If yes, what is the date, amount paid and description of each loss or claim?
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Coverage Information
Current Insurance Company
How much are you paying now?
What is the liability limit requested?
$100,000
$300,000
$500,000
$1,000,000
What is the building coverage requested?
What is the other structures coverage requested?
What is the contents property coverage requested?
What is the loss of income requested?
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