Insurance Roof Confirmation

INSURANCE ROOF CONFIRMATION

Insured Name:   Policy Number:

Property & Policy Details

Insured Date of Birth:   Agent / Broker:

Inspection Details

Inspection Date:   Inspector Name:

Roof Characteristics

Primary Material:

Asphalt Shingle    Metal    Tile    Composition    Built-up / Flat    Other

Roof Age (years):   Approx. Last Replacement Date:

Number of Existing Layers:   Roof Pitch / Slope:

Observed Condition and Damage

Observed Conditions (check all that apply):

Missing or torn shingles    Wind damage    Hail damage    Evidence of leaks / water staining    Damaged flashing / penetrations

Granule loss / bald spots    Moss / vegetation growth    Sagging / structural concerns    Other (describe below)

Documentation & Photographs

Documentation provided with this confirmation:

Photographs of damage / full roof    Contractor estimate    Previous replacement invoice

Building permit / inspection records    Aerial / drone images

Coverage Determination & Cost Estimates

Recommendation (select one):    Accept for coverage under current policy    Full replacement recommended    Repair only recommended    Further assessment required

Exclusions, Limitations, and Owner Responsibilities

The insurer's acceptance of this Roof Confirmation is conditioned upon the following limitations and acknowledgements. This confirmation documents observed roof condition at the time of inspection only and is not a guarantee of future performance. Known exclusions include concealed damage, preexisting structural defects not visible at time of inspection, damage resulting from wear consistent with expected useful life, and modifications not disclosed to the insurer.

The undersigned insured acknowledges responsibility to maintain the roof in a state that limits progressive damage, to obtain any necessary permits for repairs or replacement, and to disclose any material prior repairs or replacements to the insurer. Failure to disclose material facts or provision of false information may result in denial of coverage or rescission of the policy.

I certify the information in this Roof Confirmation is true and complete to the best of my knowledge.
I authorize the inspector and contractor named herein to share this report and supporting documentation with the insurer and representatives for underwriting or claim purposes.
I understand that additional documentation or full replacement estimates may be required prior to payment.

Certification

By signing below, the insured certifies under penalty of perjury that the statements made in this Roof Confirmation are true and complete. The insured acknowledges that material misrepresentation or omission may be grounds for denial of a claim, policy adjustment, or cancellation. The insured further authorizes the insurer, its agents, and the inspector to rely on this confirmation for underwriting or claim decisions and to request additional documentation as necessary.

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