In the state of Texas, homeowners looking for ways to reduce their residential insurance premiums may find a solution through the Texas Department of Insurance Property and Casualty Section’s initiative. The Texas PC068 form, a crucial document for those aiming to achieve this financial benefit, serves as a bridge between roofing installation and insurance savings. Tailored specifically for personal and commercial lines, this form must be completed by the roofing company as a certification of the roofing installation. Not only does it facilitate a potential reduction in insurance costs for the homeowner, but it also emphasizes the compliance of the installed roof with the stringent requirements set by Underwriters’ Laboratory Standard 2218. However, it's vital for homeowners to understand that this certificate, while beneficial in lowering insurance premiums, does not serve as a warranty from the roofing contractor, manufacturer, or supplier regarding the roof's overall quality or performance. The certification process, including the provision of detailed installation information such as the manufacturer’s specifications and the roof covering’s impact resistance classification, requires meticulous attention to ensure accuracy and compliance. Additionally, the form stipulates specific labeling requirements for roofing materials, aimed at enhancing transparency and accountability in roofing installations post-January 1, 1999. This completion and submission of this form, which is accompanied by a mention of potential legal implications for intentional misrepresentation, underscores the seriousness and significance of this process for all parties involved.
| Question | Answer |
|---|---|
| Form Name | Texas Form PC068 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 24 |
| Avg. time to fill out | 5 min 22 sec |
| Other names | pc068, information certification form pdf, information certification form online, tx certification form |
Texas Department of Insurance
Property and Casualty Section – Personal and Commercial Lines Office
Mail Code
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:
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Address of Residence (Installer must complete the following information before signing form)
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Address: |
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I, |
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, an authorized representative of |
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roofing company, do hereby certify that |
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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:
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Class 2 |
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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.
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After January 1, 1999, all individual shingles, tiles, shakes, panels, sheets, etc. must be labeled |
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with the information outlined above. |
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Original Signature of Roofing Company’s Authorized Representative |
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ONE COPY TO BE RETAINED BY HOMEOWNER |
SECOND COPY TO INSURANCE COMPANY |
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Any intentional misrepresentation relating to the completion or presentation of this form constitutes fraud.
PC068 Rev. 10/04 |
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