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FloodPath Commercial Flood Field Questionnaire

Separate commercial / General Property flood questionnaire built from the commercial IA firm template and related field survey requirements.

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Download FloodPath Commercial Flood Field Questionnaire DOCX

A. Policy, Claim & Contact Information

Policyholder / Company Name: __________________________________________Claim Number: ____________________ Policy Number: ____________________Date of Loss: ____________________Loss Location / Building Address: __________________________________________City: ____________________ State: ____________________ ZIP: ____________________Mailing Address: __________________________________________Best Contact Number: ____________________ Alternate Contact Number: ____________________Email Address: __________________________________________Agent Information: Name ____________________ Phone ____________________ Email ____________________

B. Ownership / Entity / Authority

Construction Date / Year built: ____________________Year of Purchase: ____________________Is this building owned by an individual? ☐ Yes ☐ No Name: __________________________________________Is this building owned by a Corporation, LLC, or other legal entity? ☐ Yes ☐ NoLegal/entity name recorded on title/deed: __________________________________________Name recorded on title/deed to the building: __________________________________________Is the building or any portion of the building leased? ☐ Yes ☐ NoPlease list all persons authorized to sign legal documents and receive checks: __________________________________________Authorized person #2 / title: __________________________________________Authorized person #3 / title: __________________________________________Is there an SBA loan on the building or contents? ☐ Yes ☐ No ☐ Unknown

C. Building, Contents & Mortgage Details

Is there a mortgage on the building? ☐ Yes ☐ No Mortgage company: __________________________________________Do you own the contents in this building? ☐ Yes ☐ NoIs there a mortgage that covers the contents? ☐ Yes ☐ No ☐ UnknownIf yes, contents mortgage company: __________________________________________Building mortgage / loan number, if available: ____________________Contents mortgage / loan number, if available: ____________________

D. Required Commercial Documents Checklist

☐ Attached ☐ Not Applicable Articles of Incorporation, if applicable, filed with Secretary of State.☐ Attached ☐ Not Applicable LLC Articles / Certificate of Formation, if applicable.☐ Attached ☐ Not Applicable Deed establishing ownership of real property.☐ Attached ☐ Not Applicable Purchase orders / books of account establishing ownership of personal property and/or stock.☐ Attached ☐ Not Applicable Rental / Lease Agreement for building and/or contents, if tenant occupied.☐ Attached ☐ Not Applicable Mortgage information showing whether mortgage applies to building and/or contents.☐ Attached ☐ Not Applicable Other insurance declarations page and policy pages showing flood coverage or flood exclusion.☐ Attached ☐ Not Applicable Operating Agreement showing who may sign and make decisions for the entity.

E. Prior Flood Loss / Property History

Have there been any prior/previous flood losses at this property? ☐ Yes ☐ No ☐ UnknownPrior loss #1: Month/Year ____________________ Amount Paid ____________________ Repairs made? ☐ Yes ☐ NoPrior loss #2: Month/Year ____________________ Amount Paid ____________________ Repairs made? ☐ Yes ☐ NoIf repairs were made, provide paid invoices, receipts, canceled checks, estimates, photos, or other repair documentation when available.

F. Other Insurance

Do you have other insurance that covers FLOOD damage or SEWER BACKUP? ☐ Yes ☐ No ☐ UnknownCarrier Name: ____________________ Policy Number: ____________________Building limit: ____________________ Contents limit: ____________________Do you have other insurance covering the building and/or contents for perils other than flood? ☐ Yes ☐ NoCarrier Name: ____________________ Policy Number: ____________________Building limit: ____________________ Contents limit: ____________________

G. Flood Event / Claim Details

Nearest body of water: __________________________________________Approximate distance from building: ____________________Date water entered building: ____________________ Time: ____________________Date water exited/receded from building: ____________________ Time: ____________________Exterior water height: ____________________ Interior water height: ____________________Additional flood/source comments: __________________________________________

H. Contractor / Repair Information

Do you intend to use a General Contractor to make repairs? ☐ Yes ☐ No ☐ UnknownContractor Name: __________________________________________Contractor Contact Number: ____________________ Email: ____________________Please keep contractor estimates/invoices itemized and separated between flood-related repairs and non-flood repairs/upgrades.

I. Payment / Advance

Where would you like the settlement/advance check sent? __________________________________________Are you requesting an Advance Payment toward your loss? ☐ Yes ☐ NoIf advance is not requested, please explain why: __________________________________________

J. Receipt Confirmations, Acknowledgements & Signature

I acknowledge receipt/access to the NFIP Flood Claims Handbook. ☐ Yes ☐ NoI acknowledge receipt/access to ICC information/pamphlet. ☐ Yes ☐ NoI acknowledge that neither the adjusting company nor the adjuster has authority to approve or deny any portion of this claim or authorize payment. ☐ AgreeI understand the SFIP requires a signed and sworn Proof of Loss within 60 days after the loss unless extended in writing, and failure to comply may result in denial. ☐ AgreeI certify/verify/state under penalty of perjury under the laws of the United States of America that the foregoing is true and correct to the best of my knowledge. ☐ AgreePrinted Name: ____________________ Title: ____________________ Email: ____________________Signature: __________________________________________ Date: ____________________Additional Comments: __________________________________________

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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.