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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Email
14. Phone
16. Can we contact you regarding your response?*

    1. Yes
    2. No
18. Have you experienced chronic or prolonged flooding conditions at your address or your area?*

    1. Yes
    2. No
20. If yes to the previous question, please provide a desctription
22. Which of the following best describes your condition*

    1. No Flooding
    2. Slight puddles of standing water/bird baths
    3. Light flooding with standing water for less than 4 hours
    4. Moderate flooding with standing water for up to 12 hours
    5. Significant flooding with standing water for 24-48 hours and roadways not usable
    6. Excessive flooding with roadways impassable for more than three days
24. Have you reported the flooding conditions experienced by you at your property or area to the city?*

    1. Yes
    2. No
26. Are you aware of the city’s flood complaint report form?*

    1. Yes
    2. No
28. Have you experienced any damages or financial expenses resulting from flooding conditions?*

    1. Yes
    2. No
30. Have you filed any claim with your insurance company regarding any damages to your property resulting from the flooding conditions?*

    1. Yes
    2. No
32. If so, Did your insurance provide adequate coverage for your damages?

    1. Yes
    2. No
34. Which of the following describes the extent of damages*

    1. $0 (No losses)
    2. Less than $5000
    3. $5001 - $10000
    4. $10000 - $20000
    5. Over $20000
36. Will you be willing to provide more feedback to the city in seeking solutions and mitigating flooding conditions*

    1. Yes
    2. No
38. Will you attend future public meetings scheduled to provide information on the city’s progress in addressing the storm water management issues*

    1. Yes
    2. No
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41. Email address

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