Roof Condition Certification Form
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1Roof Condition Certification Form
APPLICANT/INSURED NAME: _________________________APPLICATION/POLICY #:_______________
ADDRESS INSPECTED: __________________________________________________________________
DATE OF INSPECTION: ________________
This Roof Condition Certification Form must be inspected and completed by a verifiable Florida-licensed
professional. Without an appropriately licensed inspector’s dated signature, the form will not be accepted. The
following
FLORIDA-LICENSED
individuals may complete this form for Citizens:
A general, residential, building, or roofing contractor
A building code inspector
A registered architect
A professional engineer
A building code official who is authorized by the State of Florida to verify building code compliance
A Florida-licensed home inspector
NOTE: This form does not verify loss mitigation features. Use Uniform Mitigation Verification Inspection Form
OIR-B1-1802.
’
R
(
T
P
R
C
R
S
F
)
OOF
WO
HOTOS OF THE
OOF
S
ONDITION ARE
EQUIRED TO BE
UBMITTED WITH THIS
ORM
Secondary Roof
Predominant Roof
Any visible signs of damage /
___________
_________________________
deterioration? (describe)
Covering Material:
Covering Material:
(e.g. curling/ lifted/ loose/
___________
_________________________
Roof Age (years):
Roof Age (years):
missing shingles or tiles,
___________
_________________________
Remaining Useful Life:
Remaining Useful Life:
sagging or uneven roof deck)
___________
_________________________
Date of Last Roofing Permit:
Date of Last Roofing Permit:
Predominant Roof
___________
_________________________
Date of Last Update:
Date of Last Update:
Yes
No
Secondary Roof
Yes
No
If updated (check one):
If updated (check one):
Full Replacement
Full Replacement
Any visible signs of leaks?
Partial Replacement
Partial Replacement
Predominant Roof
% of Replacement
___________
% of Replacement
___________
Yes
No
Secondary Roof
Overall Condition of Roof:
Overall Condition of Roof:
Yes
No
Excellent
Excellent
Good
Good
Fair
Fair
Poor (explain)
Poor (explain)
Additional Comments:
A
R
C
C
I
,
L L
O O F
O N D I T I O N
E R T I F I C A T I O N
N S P E C T I O N S M U S T B E I N S P E C T E D
S I G N E D A N D C O M P L E T E D B Y A V E R I F I A B L E
F
- L
I
. I
.
L O R I D A
I C E N S E D
N S P E C T O R
C E R T I F Y T H A T T H E A B O V E S T A T E M E N T S A R E T R U E A N D C O R R E C T
_____________________________
__________________
Inspector Name (printed)
Telephone Number
_____________________________
__________________
_______________ _______
Signature of Inspector
License Type
License Number
Date
CIT RCF-1 09 12
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