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Supplemental Application Ap 20 - Insured'S Mitigation Verification Affidavit- Commercial

SUPPLEMENTAL APPLICATION AP 20

INSURED’S MITIGATION VERIFICATION AFFIDAVIT- COMMERCIAL

Policyholder Name - _________________________________ Policy Number - ___________________

Property Address - ____________________________________________________________________

Opening Protection

1. Have storm shutters meeting the minimum requirements for the International Building Code been

installed on all windows? Verification requirement is proof of installation at time of submission.

Yes_______ No_______

2. Has impact resistant glass meeting the minimum requirements of the 2009 North Carolina Building

Code been installed? Verification requirement is proof of installation at time of submission.

Yes_______ No_______

Roof

1. Attachment – Is sheathing attached in compliance with the 2006 North Carolina Building Code or an

engineered design for the wind speed for the site on which the home is located? Verification requirement

is inspection report by licensed North Carolina Building Inspector or Contractor at time of submission.

Yes_______ No_______

2. Roof-to-Wall Connection - Are there toe nails, clips, single straps and/or double straps that are installed

to meet 2006 North Carolina Building Code wind speed resistances or an engineered design for the wind

speed for the site on which the home is located? Verification requirement is inspection report by licensed

North Carolina Building Inspector or Contractor at time of submission.

Yes_______ No_______

Toe nails

Clips

Single straps

Double straps

3. Secondary Water Resistance - Does the roof have roofing felt or other approved layer or

protection between the shingles and the roof sheathing below? All secondary water resistance products

must be installed per the manufacturer’s instructions.

Yes_______ No_______ Not Verified_______

Building Codes

1. Is the structure built to meet or exceed the 2002 North Carolina Building Code? Was the structure’s

certificate of occupancy (CO) issued in 2002 or later?

Yes_______ No_______

AP 20 05 10 edition

Supplemental Application Ap 20 - Insured'S Mitigation Verification Affidavit- Commercial