Kent County Preliminary Private Damage Assessment Form

April 2013 Storms/Flooding Event

This form is being used for the collection of preliminary damage assessment purposes only. It is voluntary and is for informational purposes to aid with the damage assessment effort. The information you provide will be combined with other data and will be sent to the State of Michigan.

This form does not constitute a claim for your private insurance purposes and does not constitute an application for assistance with any governmental agency, including FEMA.

Click Continue when you have finished adding information.

Flood Damage Information

 Owner     Renter

Renters: enter Zero. Owners: Enter best guess, estimating a dollar amount of structure loss.

Enter best guess, estimating the dollar value of personal property loss. This includes clothes, furnishings, vehicles, etc.

 Flood Insurance

 Homeowners Insurance

 Renters

 None

 Unknown

If you have insurance that covers the damage, enter the deductible. If the loss is less than the deductible, enter the LOSS (not the deductible). If you don't have insurance, put the total of the structure + property loss.

 Yes     No

 Yes     No

 Affected: Habitable / usable; requires mostly cosmetic repairs

 Minor: Not habitable / usable, but can made so in short period of time; minor repairs only

 Major: 50% or more damage; not habitable / usable; requires extensive repairs

 Destroyed: 100% damage; not habitable / not usable

Provide a date and brief description of relevant damages

This form is being used for the collection of preliminary damage assessment purposes only. It is voluntary and is for informational purposes to aid with the damage assessment effort. The information you provide will be combined with other data and will be sent to the State of Michigan.

This form does not constitute a claim for your private insurance purposes and does not constitute an application for assistance with any governmental agency, including FEMA.

Questions regarding this form can be directed to Jack Stewart, Emergency Management Coordinator at 616-632-6255.