Insurance Roof Replacement Confirmation

INSURANCE ROOF REPLACEMENT CONFIRMATION

Insured Information

Date of Birth:

Policy and Claim Information

Insurer Name:

Policy Number:    Policy Type:

Policy Period: From to

Claim Number:    Adjuster Name:

Contractor and Work Details

Contractor Contact Phone:    Email:

Date Work Commenced:    Date Work Completed:

Roof Material(s) Installed:

Roof Area (square feet):    Number of Layers Removed:

Coverage and Payment Details

Replacement Estimate (Initial): $    Final Invoice Amount: $

Deductible Applied: $    Depreciation Retained: $

Permits, Inspections and Liens

Documentation Checklist

Please indicate which documents are attached to this confirmation:

Exclusions and Conditions

The Insured acknowledges that payments under the policy are subject to the policy terms, conditions and exclusions. This confirmation does not expand coverage or override policy provisions. Excluded items include, but are not limited to, damage arising from ordinary wear and tear, pre-existing damage not caused by the covered loss event, and code upgrade costs unless specifically allowed by the policy. The Insured further acknowledges that any misrepresentation or omission of material facts may result in denial of coverage and recovery actions by the insurer.

Beneficiary / Payee for Recoverable Depreciation

If recoverable depreciation or additional reimbursement is to be paid to a payee other than the Insured, provide payee details below. If not applicable, enter Insured Name as payee.

Applicant Declaration and Certification

I hereby certify, under penalty of perjury, that the statements contained in this Roof Replacement Confirmation and any attachments are true and complete to the best of my knowledge. I confirm that the roof replacement described above was completed in a workmanlike manner consistent with applicable building codes and industry standards. I further certify that all invoices, permits and lien waivers provided are accurate and correspond to the work performed.

I understand and agree that this confirmation may be relied upon by the insurer for release of recoverable depreciation, final payment, or adjustment of the claim. I authorize the insurer to communicate with the listed contractor for purposes of claim verification. I acknowledge the insurer retains all subrogation rights and that payments made pursuant to this confirmation do not waive insurer rights to recover against third parties where applicable.

Sign Now