Damage form for business - 6/9/20 | King County

        Business Name
        
        Business Type
        
        Degree of Damage
        
        Facility Owner or Renter
        
        Street Address
        
        City
        
        ZIP Code
        
        Business occupant
        
        Estimated Pre Disaster FMV of Bus.
        
        Estimated Structure Loss
        
        Est. $ Loss Furnishing / Inventory
        
        Estimated economic activity loss
        
        Cause of primary damage
        
        Type of insurance
        
Civil Unrest Insurance or Rider?
  
        Deductible
        
        Amount of insurance for facility (if known)
        
        Amount of insurance for contents (if known)
        
        # of days closed due to disaster
        
        Business Continuity Insurance?
        
Date Damage Occurred
  
  :
  
        Description of damages
        
        Contact Name
        
        Contact Phone
        
        Contact Email
        
 Location
  Street
  
  City
  
  State
  
  Zip

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Damage form for business - 6/9/20

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