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Roofing Certificate Sample

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NOTICE TO HOMEOWNER: Completion of this certificate will entitle you to a credit on your residential insurance premium. This form is solely for the purpose of enabling residential property owners to obtain a credit on their residential insurance premium and it is not to be construed as any type of express or implied warranty by the manufacturer, supplier or installer.

Roofing Installation Certification

Name of Roofing Company

Street Address

City, State, Zip

PhoneLicense # (if any)

Address of Residence (Installer must complete the following information before signing form.)

Name of Owner

 

Home Phone

 

 

Address

 

 

 

Work Phone

 

 

City, State, Zip

 

 

 

 

 

 

I,

 

 

, an authorized representative of

 

 

 

 

 

 

 

Print Name of Representative

 

 

 

 

 

 

, do hereby certify that

 

 

 

 

 

 

 

 

 

 

 

Print Name of Roofing Company

I have installed in accordance with the manufacturer's specifications on the above described residence a roof covering listed as complying with Underwriters' Laboratory Standard 2218, Impact Standard for Impact Resistance of Prepared Roof Covering Materials with an impact resistance classification of:

Class 1

Class 2

 

Class 3

Class 4

Manufacturer's Name

 

 

Brand Name

 

 

 

Year Manufactured

 

 

 

Date of Installation

 

 

 

 

 

 

 

 

 

 

 

The roof covering installed on this residence meets one of the following requirements:

The roof covering product packaging indicates the U.L. Classification under U.L. Standard 2218, the manufacturer's name, the date of manufacture, and the brand name. A label from the packaging has been supplied to the owner of the residence; or

The metal roof covering is 26 gauge or thicker material, and is installed over solid underlayment.

 

 

 

 

 

Original Signature of Roofing Company's Authorized Representative

 

Date

 

 

 

 

 

Policyholder's Signature

 

Date

 

One copy for Insurance Company

 

Second Copy to Policyholder

OFB 8350 09-12

 

 

 

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Instructions on Utilizing Roofing Certificate

Once you have gathered all necessary information, follow these steps to complete the Roofing Certificate form accurately. This will ensure you receive the appropriate reduction in your residential insurance premium.

  1. Enter the Name of Roofing Company at the top of the form.
  2. Fill in the Street Address, City, County, and Zip Code of the roofing company.
  3. Provide the Phone number and License Number (if applicable) for the roofing company.
  4. Complete the section titled Address of Residence with the homeowner's details:
    • Name of Owner
    • Home Phone
    • Office Phone
    • City
    • County
    • Zip Code
  5. In the certification statement, fill in the name of the authorized representative of the roofing company.
  6. Specify the roof covering installed, ensuring it complies with the manufacturer’s specifications.
  7. Indicate the impact resistance Classification of the roof covering (Class 1, Class 2, Class 3, or Class 4).
  8. Provide the Manufacturers’ Name, Brand Name, and Year Manufactured.
  9. Fill in the Date of Installation.
  10. Check the appropriate box regarding the labeling of products.
  11. Obtain the Original Signature of the roofing company’s authorized representative and date it.

After completing the form, retain one copy for your records and provide the second copy to your insurance company. Ensure all information is accurate to avoid any issues with your insurance premium reduction.

Misconceptions

Here are some common misconceptions about the Roofing Certificate form:

  • It guarantees a lower insurance premium. The form is intended to help homeowners qualify for a reduction, but it does not guarantee that the premium will be lower.
  • It serves as a warranty for the roofing materials. The certificate is not a warranty from the manufacturer, supplier, or installer regarding the roofing materials.
  • Any roofing company can fill it out. Only authorized representatives of the roofing company can complete and sign the form.
  • Homeowners can submit it at any time. The form should be completed and submitted after the installation of the roof covering to be valid.
  • All roofing materials qualify for premium reductions. Only materials that meet the specified U.L. Standard 2218 classifications are eligible for consideration.
  • Homeowners must keep the original copy. Homeowners are required to retain one copy, but the insurance company also needs a copy.
  • It is only for residential properties. While primarily for residential properties, some commercial properties may also benefit from similar forms.
  • It can be used for any type of roof installation. The form is specifically for roofs that comply with the impact resistance standards outlined.
  • Misrepresentation is a minor issue. Any intentional misrepresentation can be considered fraud, which has serious consequences.

Documents used along the form

When applying for a Roofing Certificate, several other forms and documents may also be necessary. These documents help ensure that all aspects of the roofing project and insurance requirements are met. Below is a list of commonly used forms that complement the Roofing Certificate.

  • Building Permit: This document is required by local authorities before starting any roofing work. It ensures that the project complies with local building codes and regulations.
  • Contractor Agreement: This is a contract between the homeowner and the roofing contractor. It outlines the scope of work, payment terms, and other important details about the roofing project.
  • Insurance Certificate: A certificate of insurance from the roofing contractor verifies that they have liability insurance and workers' compensation coverage. This protects the homeowner from potential liabilities during the project.
  • Warranty Document: This document provides details about the warranty offered on the roofing materials and installation. It outlines what is covered and the duration of the warranty.
  • Inspection Report: After the roofing work is completed, an inspection report from a licensed inspector confirms that the installation meets all safety and quality standards.
  • Change Order Form: If any changes are made to the original contract during the roofing project, a change order form documents those modifications and any additional costs involved.
  • Trailer Bill of Sale: This form is essential for documenting the sale of a trailer in New York, ensuring legal protection for both buyer and seller; learn more.
  • Final Payment Invoice: This is the invoice that the homeowner receives upon completion of the roofing project. It details the final amount due, including any adjustments for changes made during the project.
  • Homeowner's Insurance Policy: A copy of the homeowner's insurance policy may be needed to process the Roofing Certificate. This document confirms the homeowner's coverage and eligibility for premium reductions.

Having these documents prepared can streamline the roofing process and ensure that all legal and insurance requirements are met. This can provide peace of mind for both homeowners and contractors alike.