Flood Hazard Exclusion Waiver

Policyholder Name:
Property Address:
Policy Number:
Date:

Waiver Acknowledgement

I acknowledge that the insurance policy referenced above does not include coverage for damages or losses caused by flood hazards of any kind. I understand and accept that:

By signing below, I confirm my understanding and acceptance of this exclusion and release the insurer from all liability relating to flood-related damages.

Policyholder Signature
Date
Insurance Agent Signature
Date