Rental / Secondary Home Damage Assessment Form

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Use this form to report damage to either:

1.) A home or apartment that you own and rent to others

2) A second home that you own, but is not your primary residence and that you do not rent to others (a "vacation" home).

If you are reporting damage to the residence that you primarily live in, Click Here.

If you are reporting damage to a business, Click Here.

Use this form to help Grays Harbor County support our request for aid from Washington State and the Federal Government. This is the first step in being able to receive aid in our County. At this point, there is no guarantee that we will receive aid. If the damage occurred outside of Grays Harbor County, please contact that county to report.

Fill this form out one time for each location where damage occurred. Do not combine locations into one form.

EVERY question must be answered in order to be processed.

Name of Person Completing form*

Address where damage Occured*

Do you rent this location to others or is this a second/vacation house?*

Estimated Strcuture Loss in Dollars*

Estimated Personal Property Loss*

Primary Cause of Damage*

If you have insurance, what is your deductible?

Is the location habitable?*

Is the location accessible?*

How many days was or will this location be unavailble to use or rent?*

Description of Damages*

Contact Name*

Contact Phone Number*

Contact Email Address*

What date did the damage occur?*

Have you completed the debris removal proccess?*

This is the first step and will help support Grays Harbor County’s request for aid at the state and federal level. We do not know yet if we will receive any aid, but this helps support our request. In the meantime, do not delay clean up and repairs. Be sure to take pictures of your losses, including the water line with a point of reference, take video if it’s helpful, and keep all photos, videos, and receipts for potential future claims with state and federal agencies.

If you also have additional damage to report for a business location, additional rental properties that you own, your personal residence, or a vacation home, please return to the main page and submit an additional form.

For assistance with needs, call Grays Harbor County Emergency Management at (360) 249-3911