Texas Form Pc068 PDF Details

Are you an individual or business located in the state of Texas and looking for assistance understanding Texas Form PC068? We know filing taxes can be confusing, but we’re here to provide clarity. In this article, we will explain everything there is to know about Texas Form PC068 – from who needs to adhere to it and the different types available, how to properly complete it, what it means for your tax return, and more. Read on for a comprehensive breakdown of all the details related to this form!

QuestionAnswer
Form NameTexas Form Pc068
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesinformation certification form pdf, roofing installation information form, information certification form sample, tx certification form

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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

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