Preferred Single Family Residential Dwelling Application

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Consumers choosing to do business directly with Private Market Flood enter: 101976000
Coverage limits
Coverage available in these amounts only.
You can quote your own policy using the Rates page AL, AZ, CA, CO, CT, DE, FL (Coverage NOT available in Monroe county), GA, HI, IA, IL, IN, KS, MA, MD, ME, MI, MS, NC, NE, NH, NJ, NM, OH, OK, OR, PA, RI, SC, VA, VT, WA, WI, WV. Because underwriting approval is only good for 60 days, applications should only be completed when you are ready to purchase coverage.
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Deductible *
Applies separately to building and contents What is a deductible? A deductible is a predetermined amount of money that the insured must pay before a claim is paid. The deductible is applied separately to building coverage and contents coverage.
Waiting Period *
Policy Start Date
Requested Effective Date *
Requested Effective Date
Cannot be more than 75 days from the date of Application. Required waiting period is 10 days unless you have an active FEMA policy or an unpaid, expired FEMA policy within its 30 day grace period.

NO COVERAGE IS BOUND UNTIL THE APPLICATION IS APPROVED BY UNDERWRITER AND THE FULL ANNUAL PREMIUM IS RECEIVED.
Each structure requires a separate application other than a detached residential garage used only as a garage.
Phone *
Phone
Property Owner Phone Numbers (not insurance agent’s phone number)
Cell Phone
Cell Phone
Underwriting information
Current cost to build new, not including land value How do I determine my replacement cost? The replacement cost of your home can be found on your homeowner's policy or an appraisal.
Expiration Date of Current Flood Policy
Expiration Date of Current Flood Policy
Please skip if you don't have a current insurance carrier.
Primary Residence *
Is this residential building lived in by the owner for at least 292 days per year? Click Here to learn why this is important.
This information can be found on your present FEMA policy, a flood zone determination from your lender, an appraisal, or an elevation certificate. Your city or county building department may be able to provide you with this information as well. If you do not know your flood zone but your lender is NOT requiring flood insurance please put UNCERTAIN
Date of Construction *
Date of Construction
Number of Floors *
Occupancy *
Check all that apply
Please indicate which diagram number best describes your foundation by choosing from the dropdown list below the illustrations.



Not Mandatory. Fill out ONLY if your lender is requiring this insurance
If applicable
Acknowledgement of Potential loss of fema subsidy
In 2014, Congress enacted the Homeowner Flood Insurance Affordability Act, which authorizes the National Flood Insurance Program (NFIP) to make a lower cost flood insurance rating option (known as grandfathering) available to property owners who have participated in the NFIP by maintaining continuous, uninterrupted coverage through NFIP. If you intentionally allow your NFIP policy to lapse and later choose to repurchase a NFIP policy, it is possible that FEMA may apply the full risk rate -- and not the grandfathered lower cost rate -- for flood insurance for this property. Applicant hereby understands and acknowledges that if continuous coverage is not maintained with NFIP, then the subject property might no longer be eligible for a grandfathering discount, and the full risk rate may apply, if at some later date insurance applicant seeks to obtain coverage from the NFIP. *
acknowledgement of availability of coverage
Applicant attests that they are aware that personal property coverage of up to $250,000 is available and excess flood insurance over $250,000 is available and requires a separate application. *
Applicant attests that they are aware that flood insurance building coverage is available up to $500,000 and excess flood insurance over $500,000 is available and requires a separate application. *
loss record
please answer yes if the following statements are TRUE and no if the following statements are FALSE.
Applicant attests that they are not aware of more than one flood loss within the past five years, unrepaired damage from a flood, a flood loss to the structure of $250,000 or greater, or that the property has been designated by FEMA as a Severe Repetitive Loss property. *
I understand that quoted premiums for properties with more than one flood loss within the past five years, properties with unrepaired damage from a flood, properties that incurred a flood loss to the structure of $250,000 or greater and any property that has been designated by FEMA as a Severe Repetitive Loss property are double those premiums quoted for properties without such losses and the policy, if issued, contains provisions for reduction and reformation of coverage if prior flood damage is discovered that has not been disclosed *
Ineligible properties
please answer yes if the following statement is TRUE and no if the following statement is FALSE.
Applicant attests that the building for which coverage is requested is NOT a Mobile Home, Condominium Unit, or Commercial Building. The building does NOT reside in an NFIP community under NFIP probation. The building is NOT located in a Coastal Barrier Resources System (CBRA zone) or an Otherwise Protected Area (OPA). NOR has the property been designated by a duly constituted State or local authority to be in violation of State or local floodplain management regulates (Section 1316). *
Payor of INITIAL policy term *

An underwriter will review your application the same or the next business day and, if approved, will email you an approved application for you to sign along with instructions on how to remit payment. This Application will be attached to and form a part of any Policy that may be issued with LEXINGTON INSURANCE COMPANY.