Flood Quote Submission

Please complete the following form to receive a flood quote. After completion our underwriter will get back with you.

Flood Quote

ANNOUNCEMENT:

****FEMA OUTAGE UPDATE: As of Thursday, April 25th, FEMA’s National Flood Insurance Program (NFIP) remains offline for everyone due to its system migration. This change is critical to the National Flood Insurance Program’s ability to provide modern & effective technology infrastructure to support business operations. We understand this impacts your business & customers. In most cases, we can provide Private Flood options. We will be able to process transactions that do not require a quote from the system such as mortgagee changes.****

Agency Information

Agency Name *

Agency Code *

Email *

Please put the information for the agent that is submitting the quote request

Agent First Name *

Please put the information for the agent that is submitting the quote request

Agent Last Name *

Please put the information for the agent that is submitting the quote request

Agency Phone Number *

Insured & Property Information

Is NFIP/FEMA required?

Yes

Private flood an option?

Yes

Will this be under a business name? *

Yes

Insured's Business Name:

Insured - First Name *

Insured - Last Name *

Add Additional Named Insured? *

Yes

Additional Insured - First Name *

Additional Insured - Last Name *

Physical Address of Property *

Country

City

State

Zip code

Legal Description

Parcel ID

Mailing address same? *

Yes

Mailing Address:

Country

City

State

Zip code

Property Purchase Date: *

Are there multiple or any detached structures on the property? *

Yes

Please describe the building for which the quote is being requested. *

Has the structure had a previous flood loss? *

Yes

Date of Loss: *

Amount of Loss: *

When does this need to be effective? *

Standard 30 days (Not for loan closing)

Loan closing requirement (No wait)

Renewal (Match current NFIP expiration date)

Requested Effective Date: *

For Renewal, Current Carrier

For Renewal, Current Policy Number

For Renewal, How many years has the insured had current policy?

For Renewal, Current policy expiration date:

Is Insurance Required for disaster assistance? *

Yes

Is the building the insured's primary residence? *

Yes

What is the building type? *

Manufactured Home

Residential

Non-Residential

Non-Residential Business

Make for Manufactured Home: *

Model for Manufactured Home: *

Serial Number for Manufactured Home: *

Length & Width for Manufactured Home: *

Is the manufactured home anchored to a permanent foundation? *

Yes

Is the manufactured home set in a mobile home park? *

Yes

Building Occupancy? *

Building Description? *

Main Dwelling

Detached Guest House

Other (Residential)

Other (Non-Residential)

Describe the building that is to be insured: *

Is the building under construction? *

Yes

Walled & Roofed? *

Yes

Is the building partially or entirely over water? *

Not over water

Entirely over water

Partially over water

What percentage of the year will the insured live in the building? *

N/A for Commercial

50% or Less

Between 51% - 79%

80% or More

Have there been any additions or extensions to the structure? *

Yes

Year Built? *

Is the property a condominium unit? *

Yes

Is the building a rental? *

Yes

Is the insured a tenant? *

Yes

Does the tenant have an insurable interest in the building coverage? *

Yes

Is the building for a non profit? *

Yes

Is Building Located on Leased Federal Property? *

Yes

Is this for a small business with less than 100 employees? *

Yes

Does the applicant have a prior NFIP Policy? *

Yes

Foundation Type *

Basement

Enclosure

Crawlspace

Slab

Enclosure or Crawlspace Square Footage? *

Square Footage of Building *

How many floors does the building have? (Excluding basement) *

Number of Detached Structures *

Number of units within the building? *

Elevator(s) servicing the building? *

Yes

Number of elevators? *

Is the machinery and equipment elevated above the building’s first floor?

Yes

Building's estimated replacement cost? (Impacts quoted premium) *

Amount of Coverage Requested for the Building *

Will there be any contents needing insurance coverage? *

Yes

For contents needing insurance, please enter coverage amount *

Is the property mixed use? *

Yes

If mixed use, what is percentage? *

Is the building for a House of Worship? *

Yes

Is the building for an agricultural structure? *

Yes

Is the basement finished or unfinished? *

Finished

Unfinished

N/A

Please provide any supporting documentation you may have, including: flood zone determinations and elevation certificates.

Document 2

Document 3

Document 4

Any additional Questions or Comments?

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