Roofing Certificate Of Completion Form PDF Details

In the heart of Texas, where the weather can be as unpredictable as the landscape is vast, homeowners are often seeking ways to mitigate the effects of severe weather conditions on their properties. One critical avenue for doing so involves the installation of robust roofing materials, capable of withstanding the rigors of harsh weather, such as hail and storms. Recognizing the importance of encouraging homeowners to take proactive steps in this direction, the Texas Department of Insurance has introduced the Roofing Installation Information and Certification form. This pivotal document, emanating from the Property and Casualty Section within the department, is intricately designed to facilitate a financial incentive for residents - a reduction in residential insurance premiums. Eligibility hinges on the installation of roof covering that aligns with the Underwriters’ Laboratory Standard 2218 for impact resistance, a criterion that underscores the material's durability against environmental elements. The form demands detailed information from roofing companies, including their credentials and specifics of the roofing material installed, certifying compliance with the stated standards. Additionally, it assures homeowners that the completion of this form does not imply any warranty on the roofing material but rather serves as a verification tool for insurance purposes. The form also outlines the consequences of fraudulent claims, underscoring the seriousness with which the Texas Department of Insurance approaches this initiative. By embedding such a system, the form not only promotes the adoption of superior roofing materials but also plays a crucial role in enhancing the resilience of residential properties in Texas, making it a cornerstone document for homeowners and roofing professionals alike.

QuestionAnswer
Form NameRoofing Certificate Of Completion Form
Form Length1 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out27 sec
Other namesclass 4 certificate, roofing certificate of completion form, class 4 roof certificate, roofing installation certification form

Form Preview Example

Texas Department of Insurance

Property and Casualty Section – Personal and Commercial Lines Office

Mail Code 104-PC, 333 Guadalupe ｺ P. O. Box 149104, Austin, Texas 78714-9104 512-305-6711 telephone ｺ 512-490-1014 fax ｺ www.tdi.texas.gov

ROOFING INSTALLATION INFORMATION AND CERTIFICATION FOR REDUCTION IN RESIDENTIAL INSURANCE PREMIUMS

NOTICE TO HOMEOWNER. Completion of this certificate will entitle you to a reduction in your residential insurance premium. This certification form is solely for the purpose of enabling residential property owners to obtain a reduction in 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.

Name of Roofing Company:

Street Address:

City:

 

County:

 

Zip Code:

 

Phone:

 

License Number (if any):

 

 

 

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

Name of Owner:

 

 

 

Home Phone:

 

Address:

 

 

 

 

Office Phone:

 

City:

 

 

County:

 

 

 

Zip Code:

 

I,

 

 

 

 

 

 

 

, an authorized representative of

 

 

 

 

 

 

 

 

roofing company, do hereby certify that

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

Manufacturers’ Name:

Brand Name:

Year Manufactured:

Labeling of Products:

 

 

Class 2

 

 

 

 

Class

3

 

 

 

 

Class

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Installation:

The roof covering installed on the above described residence bears the following label:

CHECK ONE BELOW

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.

Each individual shingle, tile, shake, panel, sheet, etc. of roof covering is separately labeled with the U.L. Standard 2218 classification and with the manufacturer’s name, the date of manufacture, and brand name.

NOTE:

After January 1, 1999, all individual shingles, tiles, shakes, panels, sheets, etc. must be labeled

 

with the information outlined above.

 

 

 

 

 

 

 

Original Signature of Roofing Company’s Authorized Representative

 

 

Date

ONE COPY TO BE RETAINED BY HOMEOWNER

SECOND COPY TO INSURANCE COMPANY

Any intentional misrepresentation relating to the completion or presentation of this form constitutes fraud.

PC068 Rev. 10/04

Page 1 of 1

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Step # 1 of filling out certificate of completion roofing

2. Once your current task is complete, take the next step – fill out all of these fields - Manufacturers Name Brand Name Year, The roof covering installed on the, Date of Installation, NOTE, The roof covering product, Original Signature of Roofing, Date, ONE COPY TO BE RETAINED BY, SECOND COPY TO INSURANCE COMPANY, Any intentional misrepresentation, PC Rev, and Page of with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Date of Installation, Any intentional misrepresentation, and ONE COPY TO BE RETAINED BY in certificate of completion roofing

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