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{"sheet":"Flood Insurance Application","index":0,"n_rows":41,"n_cols":12,"rows_kept":41,"cut":false,"hidden":false,"merged":[[10,1,10,7],[10,8,10,9],[0,1,0,11],[2,1,2,11],[3,1,3,11],[4,1,4,11],[5,1,5,9],[5,10,5,11],[6,1,6,9],[6,10,6,11],[7,1,7,11],[8,1,8,11],[9,1,9,11],[11,1,11,7],[11,8,11,9],[12,1,12,11],[13,1,13,2],[13,3,13,4],[13,5,13,11],[20,1,20,6],[20,7,20,9],[14,1,14,2],[14,3,14,4],[14,5,14,11],[15,1,15,11],[16,1,16,6],[16,7,16,11],[17,1,17,6],[17,7,17,11],[18,1,18,11],[19,1,19,6],[19,7,19,9],[28,1,28,6],[28,7,28,9],[28,10,28,11],[21,1,21,6],[21,7,21,11],[22,1,22,6],[22,7,22,11],[23,1,23,6],[23,7,23,9],[24,1,24,6],[24,7,24,9],[25,1,25,11],[26,1,26,11],[27,1,27,11],[33,10,33,11],[29,1,29,6],[29,7,29,9],[29,10,29,11],[30,1,30,6],[30,7,30,9],[31,1,31,6],[31,7,31,9],[38,1,38,11],[39,1,39,11],[40,1,40,11],[41,1,41,11],[1,1,1,11],[34,1,34,6],[34,7,34,9],[35,1,35,6],[35,7,35,9],[36,1,36,11],[37,1,37,11],[32,1,32,6],[32,7,32,9],[32,10,32,11],[33,1,33,6],[33,7,33,9]]}
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[]
[null,"Please complete all sections. A signed application is not required for quote, but is required prior to binding coverage. \nSend submissions to controldesk@riskinsbrokers.com. Questions? 855-429-2425 or info@riskinsbrokers.com."]
[null,"STATEMENT OF INTENT"]
[null,"I / We hereby declare that the following statements and specifics, including the submitted Schedule of \nLocations and Values, are true and that I/we have not suppressed or misstated any material facts. "]
[null,"Applicant Signature:",null,null,null,null,null,null,null,null,"Date:"]
[]
[null,"SECTION 1 - APPLICANT INFORMATION"]
[null,"Applicant Name:"]
[]
[null,"Mailing Address:",null,null,null,null,null,null,"City:",null,"State:","Zip:"]
[]
[null,"SECTION 2 - PROPOSED POLICY TERM"]
[null,"Eff. Date:",null,"Exp. Date:",null,"Effective at 12:01 A.M. Local Time at the insured mailing address:"]
[]
[null,"SECTION 3 - COVERAGE LIMITS AND DEDUCTIBLE"]
[null,"Coverage Limits Requested:",null,null,null,null,null,"Deductible Requested: "]
[]
[null,"SECTION 4 - UNDERLYING FLOOD CARRIER INFORMATION"]
[null,"Primary Flood Company:",null,null,null,null,null,"Policy Number:",null,null,"Eff. Date:","Exp. Date:"]
[]
[null,"Primary Policy Limits:",null,null,null,null,null,"Primary Policy Deductible:"]
[]
[null,"Excess Flood Company:",null,null,null,null,null,"Policy Number:",null,null,"Eff. Date:","Exp. Date:"]
[]
[null,"Excess Policy Limits:"]
[]
[null,"SECTION 5 - ADDITIONAL INTERESTS"]
[null,"Additional Interest Name:",null,null,null,null,null,"Type: (Mortgagee, Loss Payee, etc.)",null,null,"Reference #"]
[]
[null,"Mailing Address:",null,null,null,null,null,"City:",null,null,"State:","Zip:"]
[]
[null,"Additional Interest Name:",null,null,null,null,null,"Type: (Mortgagee, Loss Payee, etc.)",null,null,"Reference #"]
[]
[null,"Mailing Address:",null,null,null,null,null,"City:",null,null,"State:","Zip:"]
[]
[null,"SECTION 6 - LOSS HISTORY"]
[null,"Please describe all flood losses to all properties considered in this application during the past 5 years:"]
[]
[null,"SECTION 7 - PROPERTY INFORMATION "]
[null,"Please complete the \"Schedule of Locations and Values\" on the second tab of this form."]

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[null,"Commercial Flood Program - Schedule of Locations and Values"]
[null,"Additional Instructions:"]
[null,"(1) Below grade - Any area of the building having its floor below ground level on all sides"]
[null,"(2) Coverage for Business Personal Property in the basement is limited to: air conditioning units; clothes washers and dryers; and food freezers."]
[]
[]
[null,"Location Number","Building Number","Location Address 1","Location Address 2","Location City","Location Zip","Location State","Construction Type","Occupancy Type","Building Square Feet (include parking)","Year Built","Stories Above Ground","Number  Floors Below Grade (1)","Total Building Value ","Building Value Below Grade (1)","Tenant Improvements Value","Annual Business Income Value (full year Business Income even if purchasing less than full year amount)","Homeowners Associaton Fees/Dues","Business Personal Property (exclude Stock & EDP)","Stock Only","EDP Only","Business Personal Property Located Below Grade (1), (2)","Business Personal Property at First Floor","Any construction occurring?","Elevators present?"]
[null,1,1,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,2,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,3,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,4,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,5,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,6,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,7,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,8,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]
[null,1,9,null,null,null,null,"CA",null,null,null,null,0,0,null,0,0,0,0,0,0,0,0,0]