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FloodPath Adjuster Field Survey Addendum

Internal adjuster-only addendum for reserve, GCF origin investigation, inspection participants, mortgage confirmation, and adjuster signature fields.

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A. Claim / Reserve Information

Named Insured: __________________________________________Claim Number: ____________________ Policy Number: ____________________Property Address: __________________________________________Mailing Address: __________________________________________Building Reserve: $____________________ If zero, explain: __________________________________________Contents Reserve: $____________________ If zero, explain: __________________________________________

B. Origin Investigation / GCF

Was there a General and Temporary Condition of Flooding? ☐ Yes ☐ No ☐ Not Confirmed YetExplain how GCF was or was not confirmed: __________________________________________Public documentation reviewed: __________________________________________Inspection/photo evidence reviewed: __________________________________________

C. Inspection Participants / Named Insureds

List all named insureds and spouses: 1. __________________________________________ Relationship: ____________________2. __________________________________________ Relationship: ____________________3. __________________________________________ Relationship: ____________________4. __________________________________________ Relationship: ____________________Who was present at inspection? __________________________________________ Relationship: ____________________

D. Mortgage / Lease Confirmation

1st Mortgage: __________________________________________ Loan # ____________________2nd Mortgage: __________________________________________ Loan # ____________________Home Equity Line: __________________________________________ Loan # ____________________Other lienholder: __________________________________________ Loan # ____________________Purchase Date: ____________________Is any part of the property held for lease? ☐ Yes ☐ No Explain: __________________________________________

E. Adjuster Certification

Adjuster Signature: __________________________________________Date: ____________________ FCN: ____________________

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Coverage Disclaimer

FloodPath provides general claim communication and documentation guidance only. Field adjusters cannot approve/deny coverage or authorize payment. Final claim decisions are made only by the Carrier.