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Name of Insured: __________________________
Property Location:
Waiting Period
Loan Clos
ing (no wait) - please provide date of closing ______ or 30 day wait __ or Lender Required (no wait) __
Other Rollover/Renewal: please give date________
Mailing same as Property Address: Yes/No: if no, please provide______________________________
Mortgagee Clause Name & Address:_________________________________________________
Essential Rating Elements
1. Wha
t is the community’s name and number? ______
2. Flood Zone Construction Date
3. Is the coverage for a condominium building? No Yes Number of Units
4. Is the coverage for a condominium unit? Yes No
5. What is the building’s occupancy type?
Single Family 2-4 Family Non-Residential Other Residential
6. How many floors does the building have (including the basement/enclosure/crawlspace)? _
7. What is the basement/enclosure type? None Finished Unfinished?
8.
Elevators Yes No How many? _______________
9. What is the amount of coverage requested for the building? $
10. What is the building’s estimated replacement cost? $ ______
11. What is the amount of coverage requested for contents? $
12. Where are the contents located? N/A (not insuring contents) Basement only
Basement and above Lowest floor only-above ground level
Lowest floor only-above ground level and higher floors Above ground level-more than one full floor
13. What is the requested deductible?
$1000 (standard post-FIRM)
$2000 (standard pre-FIRM) $3000 $4000 $5000
Higher deductibles for Other Residential and Non Residential only:
$10,000 $15,000
$20,000 $25,000 $50,000 (only when insuring building & contents)
14. Attached Garage?
Yes No If yes, provide square footage _____ Is garage used solely for parking of vehicles, building
access, and/or storage?
Yes No Is the garage finished (more than 20 linear feet of finished wall, paneling? Yes No
Number of permanent openings (vents) within 1 ft. of adjacent grade: _____, Total area of all permanent openings: _____square
inches
Please note: If the building is Post FIRM construction, located in any of the ‘A’ or ‘V‘ zones, an elevation certificate will be required for rating. If
applicable, please include a copy of the elevation certificate with this rating sheet. If the Elevation Certificate shows a Diagram number 6, 7, 8
or 9 then please provide the square footage of the enclosure/crawlspace.
For mobi
le homes only: If the structure to be insured is located in a mobile home park, please provide the year the park was established as the
date of construction. If the structure is located on private property, please provide the date it was placed on a permanent foundation on that
property.
