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FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. N03067-0077 NATIONAL FLOOD INSURANCE PROGRAM fxpiresMay31, 1993 FLOODPROOFIIVG CERTIFICATE FOR NON-RESIDEIVTIAL STRUCTURES The floodproofing of non-residential buildings may be permitted as an alternative to e/evating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. F/oodproofing of a residentia/ building does not a/ter a community`s floadp/ain management e/evation requirements or effect the insurance rating un/ess the community has been issued an exception by FEMA to allow floodproofed residentia/ basements. The permitting of a f/oodproofed residentia/ basement requires a separate certification specifying that the design complies with the /ocal f/oodp/ain management ordinance. FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) CITY STATE ZIP CODE SECTIQN I FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER PANEL NUMBER SUFFIX DATE OF FIRM INDEX FIRM ZONE BASE FLOOD ELEVATION (in AO Zones, use depth) SECTION II FLOODPROOFING INFORMATION (By a Registered Professional Engineer or Architect) Floodproofing Design Elevation Information: Building is floodproofed to an elevation of U feet NGVD. (Elevation datum used must be the same as that on the FIRM.) Height of floodproofing on the building above the lowest adjacent grade is W. U feet. (NOTE: for insurance rating purposes, the building's floodproofed design e/evation must be at least one foot above rhe Base Flood E/evafion to receive rafing credit. If the building is f/oodproofed on/y to the Base F/ood E/evation, then the building's insurance rating will result in a higher premium.) SECTION III CERTIFICATION (By a Registered Professional Engineer or Architect) Non-Residential Floodproofed Construction Certification: 1 certify that based upon development and/or review of structural design, specifications, and p/ans for consfruction that the design and methods of construction are in accordance with accepted standards of pracfice for meeting the following provisions: The structure, together with attendant utilities and sanitary facilities, is watertight to the floodproofed design elevation indicated above, with walls that are substantially impermeable to the passage of water. All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated debris impact forces. 1 certify that the information on this certificate represents my best efforts to interpret the data available. 1 understand that any false stafement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) TITLE COMPANY NAME ADDRESS CITY STATE ZIP SIGNATUPE DATE PHONE Copies should be made of this Certificate for: 1) community official, 2) insurance agent/comparsy, and 3) building owner. FEMA Form 61-65, MAY 90 REPLACES EDITION OF JUN 87, WHICH IS OBSOLEP€.