roofing form

Does anyone have a Roof certification Form that is NOT in PDF format??
Please email me at

Sorry I don’t. I was trying to convert one this weekend to no avail. If you get one will you share?

This help?
Just copy and paste to word.

**Roof Condition Certification Form **APPLICANT/INSURED

_____________________________ ___________________________
DATE OF INSPECTION:_________________

This form is provided to assist you in complying with certain Citizens eligibility rules. A Florida licensed roofing contractor must complete this form.
(Note: This form
**does not **verify loss mitigation features. Use Uniform Mitigation Verification Form, OIR-B1-1802.)

**Certification Information
Roof Covering: ______________
Approximate remaining useful life of the roof: __________
Age of roof (in years): _________________
Date last updated? _______________________________
What, if any, updates were completed? Full Replacement Partial Replacement
Are there any visible signs of damage/deterioration (such as curling/lifted/loose/missing shingles or tiles, sagging or uneven roof deck, etc.)? Yes No. If yes, explain________________________________
Are there any visible signs of leaks? Yes No. If yes, explain______________________________

**Two photos representing the roof’s condition are required to be submitted with this form.
**Florida Fraud Statement
Any person who knowingly and with the intent to injure, defraud, or deceive any insurer, files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

Name of Licensed Roofing Contractor (printed) Telephone Number

Signature of Licensed Roofing Contractor License Number Date