Get Citizens RCF-1 2012-2024

Use Uniform Mitigation Verification Form OIR-B11802. 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 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. Inspector Name printed Telephone Number Signature of Inspector License Type CIT RCF-1 02 12 rev. License Number Date. Roof Condition Certification Form APPLICANT/INSURED NAME APPLICATION/POLICY ADDRESS INSPECTED DATE OF INSPECTION This form is provided to assist you in complying with certain Citizens eligibility rules. The following qualified inspectors may complete the form A Florida-licensed general residential building or roofing contractor A Florida-registered architect A building code official who is authorized by the State of Florida or its counties municipalities to verify building code compliance Note This form does not verify loss mitigation features. Use Uniform Mitigation Verification Form OIR-B11802. 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 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. Inspector Name printed Telephone Number Signature of Inspector License Type CIT RCF-1 02 12 rev* License Number Date. Roof Condition Certification Form APPLICANT/INSURED NAME APPLICATION/POLICY ADDRESS INSPECTED DATE OF INSPECTION This form is provided to assist you in complying with certain Citizens eligibility rules. The following qualified inspectors may complete the form A Florida-licensed general residential building or roofing contractor A Florida-registered architect A building code official who is authorized by the State of Florida or its counties municipalities to verify building code compliance Note This form does not verify loss mitigation features. The following qualified inspectors may complete the form A Florida-licensed general residential building or roofing contractor A Florida-registered architect A building code official who is authorized by the State of Florida or its counties municipalities to verify building code compliance Note This form does not verify loss mitigation features. Use Uniform Mitigation Verification Form OIR-B11802. 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 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.