Pre-Flood Property Condition Declaration

Property Information

Property Address Owner(s) Name Contact Number Email Address

General Property Condition (Prior to Flood Event)

Building Structure Excellent Good Fair Poor Roof Condition Excellent Good Fair Poor Interior Condition (Walls, Flooring, Fixtures) Excellent Good Fair Poor Electrical and Plumbing Condition Excellent Good Fair Poor HVAC/Heating Systems Condition Excellent Good Fair Poor

Additional Details

Recent Repairs or Renovations (Describe any significant work completed within last 3 years) Visible Signs of Damage or Issues Prior to Flood (e.g., cracks, leaks, mold)

Declaration

I declare that, to the best of my knowledge, the information provided above is true and correct as of the date signed below.