Insurance Replacement Flood Quote

INSURANCE REPLACEMENT FLOOD QUOTE

Quote Number:    Date of Quote:

Insured / Applicant Information

Date of Birth:    Phone:    Email:

Policy Details & Replacement Estimates

Policy Type: Building Replacement Coverage Contents Replacement Coverage Additional Living Expense (ALE)

Deductible:    Estimated Annual Premium:

Policy Period: From to    Proposed Effective Date:

Coverage Options & Limits

Select coverages being quoted (check as applicable):

Base Flood Insurance (Standard)
Replacement Cost Coverage (no depreciation)
Contents Replacement Coverage
Increased Cost of Compliance (ICC)
Debris Removal
Loss Assessment
Ordinance or Law Coverage

If Replacement Cost Coverage selected, maximum additional limit for contents:

Exclusions & Important Notices

The quote set forth herein is subject to underwriting and is not a binder. Coverage is subject to terms, conditions and exclusions of the policy form. Typical exclusions include but are not limited to: loss due to earth movement not caused by flood, gradual deterioration, government action, faulty workmanship unrelated to flood, war or nuclear hazard, and pre-existing contamination. This quote does not include coverage for damage to property below the lowest floor when specifically excluded by endorsement.

Applicant acknowledges that replacement cost coverage may require post-loss documentation and proof of value, and that final settlement may be subject to depreciation if policy conditions are not met. Applicant further acknowledges that certain property types and uses may be ineligible for flood replacement coverage.

I acknowledge receipt of the above exclusions and understand that the final policy may contain additional exclusions and limitations. Acknowledged

Underwriting Requirements & Documentation

The following documentation is required for binding and final issuance of replacement flood coverage. Check the documents being provided with this quote submission:

Elevation Certificate
Proof of Ownership / Deed
Photos of Property Condition
Previous Flood Loss/Claims History
Replacement Cost Estimate / Appraisal

Beneficiary / Loss Payee Information

Relationship to Insured:    Share (%):

Premium, Fees, Validity and Payment

Estimated premium shown is an indication only and is subject to change pending underwriting review, inspection, and receipt of required documentation. Applicable taxes, assessments and fees are not included unless specifically stated. Premium due upon binding unless alternative arrangements are authorized in writing by the insurer.

Quote Validity (days):    Proposed Payment Frequency: Annual Monthly (subject to installment fees)

Certification and Applicant Authorization

By signing below, the applicant certifies that all information provided in this quote request is true and complete to the best of the applicant's knowledge. The applicant understands that material misrepresentation, omission, or concealment of a fact may be grounds for denial of coverage or rescission of the policy. Applicant authorizes the insurer and its representatives to obtain and verify information necessary for underwriting, including loss history, claims records and other insurance-related data. Applicant agrees to provide any additional documentation reasonably requested by the insurer to confirm eligibility for replacement flood coverage.

Applicant further acknowledges that acceptance of this quote and issuance of a policy is contingent upon completion of underwriting, payment of premium, and receipt of required documentation. This document is an insurance quote and not an insurance policy.

I certify that the property information provided accurately describes the risk.
I have disclosed all prior flood loss experience for the property listed.
I consent to an inspection of the property if required by underwriter.

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