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Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
Please complete this form to report damage caused by a disaster in Berrien County. Never place your self in danger to inspect damage. Use your best judgment as we will verify the information at a later date.
Do not use this form to request emergency assistance. You will need to call 911 for an emergency. Leave answers that don't apply blank unless they require an answer.
Estimate to the best of your ability if you don't know exactly. Use the above to express the date and time the event started and the date and time it ended.
Indicate the type of property that was damaged by the disaster. Also, indicate if injuries occurred. Check ALL that apply.
Provide the address of the location damaged. Please don't abbreviate (use "East' not "E", and "Road", not "Rd")
Check the owner box if you are the owner:
Provide best estimate of value of property (before damaged).
Provide amount estimated and cost of repair.
Estimate percentage your insurer will cover. If uninsured, use 0.
Is the damaged property insured?
Select if damage caused by flood
Inaccessible means inspection isn't possible or dangerous right now.
Estimate the time it will take to resume normal use.
(ie. for a house - when can someone live in it)
Estimate the height of flood waters to any occupied or required room. Unfinished rooms where occupancy isn't normal do not apply here.
Estimate the level of water for Manufactured/Mobile homes.
Check all that apply
Indicate damage that is described below. Structural components described below are: windows, doors, wall coverings, roof, bottom board insulation, ductwork, or utility hook-up
Entered if you are a damage assessor
Current Assessment by Damage Assessors
Submit photos of the property or building that is damaged. Start with Long range overview photos of each of the 4 sides of the property. Then get closer shots of damage to show mid-range or close-up views. Never put yourself in danger to inspect damage.
Wide range photos
Wide Range Photos
Overview of opposing side
Photo specifically highlighting damage
Email firstname.lastname@example.org if you have more extensive comments. Refer to the name given above.
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