June 2020 - Business Damage Form | King County

        Business Name
        
        Type of business
        
        Business Owner Name
        
        Business Contact Name
        
        Business Contact Phone
        
        Business Contact Email
        
        Business Location: Street Address, City, ZIP Code
        
        Is facility rented or owned?
        
        If facility is rented, list facility owner contact name and information, if known
        
        Degree of Damage
        
        Estimated Pre-Disaster Fair Market Value of Business (best guess of building value before damages)
        
        Estimated Structure Loss (estimated monetary damages to facility)
        
        Estimated Dollar Loss Furnishings/Inventory (estimated monetary loss of inventory and contents – including tenant improvements) 
        
        Estimated economic activity loss (estimated loss of revenue from closure) 
        
        Primary Cause of Damage
        
        Description of damages (structure, contents)
        
Date Damage Occurred
  
  :
  
        Type of insurance
        
Civil unrest insurance or rider (yes/no)
  
        Deductible amount
        
        Amount of insurance coverage for facility (if known)
        
        Amount of insurance coverage for contents (if known)
        
        Number of days closed due to disaster
        
Do you have Business Continuity Insurance?

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June 2020 - Business Damage Form

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