Serving Clients Since 1927

Omaha (402) 398-9009 | Kearney (308) 234-5258

Flood Insurance Form

    Complete this form for a Flood Proposal.


    Mailing Address



    Zip Code


    Email Address

    Property Location

    Property Address



    Zip Code


    Lender Name

    Loan Number

    Mailing Address



    Zip Code

    Rating Information

    Building Occupancy
    Single Family2-4 FamilyOther ResidentialNon-Residential

    Basement\Encloser (all four sides underground)

    Building Type (include basement if any)
    1 Floor2 Floors3 FloorsSplit-levelMobile home

    Is the property owned by the government?

    Is the building in the course of construction?

    Years of Construction

    Contents Located
    Basement onlyBasement and aboveLowest floor above groundLowest floor above ground and higherAbove ground level, more than one floor

    Are contents household?

    if no, describe:

    Replacement Cost of Building

    Amount of Insurance

    Residential Building (up to $250,000)

    Residential Contents (up to $100,000)

    non-Residential Building (up to $500,000)

    non-Residential Contents (up to $500,000)


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