January Storm Damage Information
Survey concerning damages for San Benito County residents affected by the Pacheco Flood
please call 831-540-8942 with any questions you have
1) First Name *
Your answer
2) Last Name *
Your answer
3) Phone Number *
Your answer
4) Email Address
Your answer
5) Address *
Your answer
6) What is your relationship to the damaged property? (own, rent, lease, manage) *
Your answer
7) What type(s) of property is/are damaged? - check all that apply *
Required
8) Please give detailed information about the number, size, and type(s) of buildings/property affected
Your answer
9) Is this property a business? (including home businesses) *
10) What is the estimated uninsured damage to the structure(s)? - please give individual estimates for each building
Your answer
11) What is estimated pre-disaster value of the structure(s)? - please give individual estimates for each building
Your answer
12) What is the estimated uninsured damage to contents? - please give individual estimates for each building
Your answer
13) What is the estimated pre-disaster contents value? - please give individual estimates for each building
Your answer
14) What is the estimated pre-disaster value of other property (excluding property contained in buildings)?
Your answer
15) Is there any other type of insurance?
16) Estimated damage/destruction to structure/property? *
17) If more than one building damaged please give detail about percentage of damage for each building individually
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