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Fill in a Valid Roofing Certificate Form

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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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Document Information

Fact Name Details
Purpose of the Form This certificate allows homeowners to qualify for a reduction in their residential insurance premiums.
Governing Body The form is regulated by the Texas Department of Insurance.
Applicable Law It is governed under Texas Insurance Code, Section 2218.
Installation Certification The roofing company must certify that the installation complies with the manufacturer's specifications.
Impact Resistance The roof covering must meet the Underwriters’ Laboratory Standard 2218 for impact resistance.
Labeling Requirements Roofing materials must be labeled with U.L. classification, manufacturer’s name, and date of manufacture.
Signature Requirement The form must be signed by an authorized representative of the roofing company.
Homeowner's Copy One copy of the completed form must be retained by the homeowner.
Insurance Company Copy A second copy must be provided to the homeowner's insurance company.
Fraud Warning Any misrepresentation on this form can be considered fraud.

Roofing Certificate - Usage Guidelines

Once you have gathered all necessary information, you can begin filling out the Roofing Certificate form. Completing this form accurately is crucial for homeowners seeking a reduction in their residential insurance premiums. Follow these steps to ensure all required details are provided correctly.

  1. Identify the Roofing Company: Write the name of the roofing company at the top of the form.
  2. Provide Company Address: Fill in the street address, city, county, and zip code of the roofing company.
  3. Contact Information: Enter the phone number and license number (if applicable) of the roofing company.
  4. Homeowner Information: In the section labeled "Address of Residence," provide the homeowner's name, home phone number, and address.
  5. Office Contact: Include the office phone number, city, county, and zip code for the homeowner's residence.
  6. Certification Statement: The authorized representative of the roofing company should write their name in the designated area, certifying the installation of the roof covering.
  7. Roofing Details: Indicate the roof covering's impact resistance classification, selecting from Class 1, Class 2, Class 3, or Class 4.
  8. Manufacturer Information: Fill in the manufacturer's name, brand name, and year manufactured for the roofing materials used.
  9. Installation Date: Write the date when the roof was installed.
  10. Labeling Confirmation: Check one of the options regarding the labeling of the roof covering product.
  11. Signature: The authorized representative must sign and date the form at the bottom.

After completing the form, retain a copy for your records and provide a second copy to your insurance company. This process will help ensure that you receive the premium reduction you are entitled to.

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Dos and Don'ts

When filling out the Roofing Certificate form, it’s important to follow certain guidelines to ensure accuracy and compliance. Here’s a helpful list of what to do and what to avoid:

  • Do provide complete and accurate information about the roofing company, including name, address, and license number.
  • Do ensure that the installation date is clearly indicated on the form.
  • Do specify the impact resistance classification of the roof covering.
  • Do include the manufacturer’s name and brand name of the roofing materials used.
  • Don't leave any sections blank; incomplete forms may delay the insurance premium reduction.
  • Don't provide false information or misrepresent any details, as this could be considered fraud.
  • Don't forget to have the authorized representative of the roofing company sign the form.
  • Don't neglect to keep a copy of the completed form for your records.

By following these guidelines, you can help ensure a smooth process for obtaining your insurance premium reduction.

Common mistakes

  1. Incomplete Information: Failing to fill in all required fields can lead to delays in processing. Ensure that every section, including the roofing company details and homeowner information, is fully completed.

  2. Incorrect Classification: Misidentifying the impact resistance classification of the roofing material can jeopardize the certification. Double-check the classification against the manufacturer’s specifications.

  3. Missing Signatures: The form must be signed by an authorized representative of the roofing company. Neglecting to provide this signature can render the certificate invalid.

  4. Failure to Attach Labels: Not including the necessary labels from the roofing product packaging can result in rejection of the form. Labels must clearly indicate the U.L. classification and other required information.

  5. Submitting to Incorrect Parties: It is crucial to send copies of the completed form to both the homeowner and the insurance company. Failing to do so may hinder the homeowner’s ability to receive their premium reduction.

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