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First Name
*
Last Name
*
Address1
*
Address2
City
*
State
*
Zip
*
Email
Phone
Can we contact you regarding your response?
*
Yes
No
Have you experienced chronic or prolonged flooding conditions at your address or your area?
*
Yes
No
If yes to the previous question, please provide a desctription
Which of the following best describes your condition
*
No Flooding
Slight puddles of standing water/bird baths
Light flooding with standing water for less than 4 hours
Moderate flooding with standing water for up to 12 hours
Significant flooding with standing water for 24-48 hours and roadways not usable
Excessive flooding with roadways impassable for more than three days
Have you reported the flooding conditions experienced by you at your property or area to the city?
*
Yes
No
Are you aware of the city’s flood complaint report form?
*
Yes
No
Have you experienced any damages or financial expenses resulting from flooding conditions?
*
Yes
No
Have you filed any claim with your insurance company regarding any damages to your property resulting from the flooding conditions?
*
Yes
No
If so, Did your insurance provide adequate coverage for your damages?
Yes
No
Which of the following describes the extent of damages
*
$0 (No losses)
Less than $5000
$5001 - $10000
$10000 - $20000
Over $20000
Will you be willing to provide more feedback to the city in seeking solutions and mitigating flooding conditions
*
Yes
No
Will you attend future public meetings scheduled to provide information on the city’s progress in addressing the storm water management issues
*
Yes
No
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