Insurance RCV Warranty Form

INSURANCE RCV WARRANTY FORM

Client Name:    Policy Number:

Applicant / Insured Information

Date of Birth:    Primary Contact Phone:    Email:

Policy Details

Coverage Limit:    Deductible:    Premium:

Policy Period From:    To:

Insured Property / Item Description

Coverage Selection

Replacement Cost Coverage (RCV)

Building Code / Ordinance Coverage

Contents Replacement Coverage

Loss of Use / Additional Living Expenses

Exclusions

The following customary exclusions, limitations, and conditions apply to RCV warranty payments. This list is illustrative and not exhaustive. Unless otherwise endorsed, the insurer will not pay RCV or depreciation replacement for loss arising from:

Claim Information (if applicable)

Date of Loss:    Time of Loss:

Documentation provided with claim (check all that apply):

Photographs of Damage

Contractor Estimates

Prior Invoices / Receipts

Police or Incident Report

Authorization to Inspect Premises:

Replacement Cost Value (RCV) Warranty — Terms and Conditions

By completing and signing this form, the Insured warrants and agrees to the following substantive conditions for payment of Replacement Cost Value (RCV) and any withheld depreciation:

1. Definitions: "Actual Cash Value" (ACV) means replacement cost less depreciation. "Replacement Cost Value" (RCV) means the cost to repair or replace damaged property with material of like kind and quality without deduction for depreciation, subject to policy limits and endorsements.

2. Condition Precedent to RCV Payment: The insurer's obligation to pay withheld depreciation or full RCV is expressly conditioned upon the Insured completing repairs or replacements of the damaged property and providing satisfactory documentation of completion, including final paid invoices, receipts, or other proof of expenditure.

3. Time to Complete Replacement: The Insured agrees to commence and diligently pursue replacement or repair work and to submit final proof of replacement within days from the date of first RCV payment, unless the insurer grants a written extension for good cause.

4. Documentation Required: The Insured must provide contractor invoices, paid receipts, canceled checks, lien waivers (if requested), and any additional documentation reasonably requested by the insurer to substantiate full replacement and cost.

5. Insurer Rights: The insurer reserves the right to inspect replacement work prior to final RCV payment, to refuse payment for work not completed in accordance with applicable codes or industry standards, and to require submission of licensed contractor documentation where required by law.

6. Salvage and Subrogation: Unless otherwise agreed in writing, the insurer may take possession of any salvaged property and is subrogated to the rights of the Insured against third parties to the extent of any payments made by the insurer.

7. Failure to Replace: If the Insured fails to replace or repair the damaged property within the timeframe without insurer consent, the insurer may retain the withheld depreciation and/or adjust payment to reflect the Actual Cash Value, subject to policy provisions.

8. Misrepresentation and Fraud: Any material misrepresentation, omission, or fraudulent act in procuring benefits under this warranty or in documenting replacement costs shall void the warranty and may result in denial of coverage and recovery of any amounts paid.

9. Indemnity: The Insured agrees to indemnify and hold harmless the insurer for any losses, costs, or liabilities arising from false statements or failure to comply with this warranty, except to the extent caused by the insurer's own breach of this warranty.

Beneficiary / Payee Designation (Optional)

Additional Remarks

Certification

I hereby certify, under penalty of law and consistent with the terms and conditions of the policy, that the information contained herein is true and complete to the best of my knowledge. I acknowledge and agree that RCV payments are conditioned on completion of replacement or repair as set forth above, and that failure to comply may result in forfeiture of RCV or other remedies available to the insurer. I authorize the insurer and its representatives to verify the information provided and to inspect the property as necessary to determine compliance with this warranty.

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