Georgia Insurance-Funded Residential Roofing Contract

GEORGIA INSURANCE-FUNDED RESIDENTIAL ROOFING CONTRACT

Before signing: Use this contract for a roof system on residential real estate constructed for one to four families, including a detached garage, when the work may be paid from property and casualty insurance proceeds. The contractor must first give the insured the bold statement and two completed, easily detachable cancellation notices below. Print those notices in bold type of at least 10 points. Attach both copies to this contract and give them to the insured.

1. Parties, property and claim

Agreement date: [__/__/____]

Owner or person in possession (Insured): [FULL LEGAL NAME]

Mailing address, phone and email: [ADDRESS; PHONE; EMAIL]

Residential roofing contractor: [FULL LEGAL NAME AND LICENSE DETAILS, IF APPLICABLE]

Contractor's business address for cancellation: [STREET, CITY, GA ZIP]

Contractor phone and email: [PHONE; EMAIL]

Work site: [STREET, CITY, GA ZIP]

Property and casualty insurer / claim number: [INSURER; CLAIM NUMBER / PENDING]

Claim status at signing: ☐ pending ☐ partly approved ☐ approved ☐ other: [DETAILS]

2. Roof work, schedule and price

Contractor will repair or replace the roof system described in the signed scope below. Contractor will obtain the permits assigned to it here, protect the work site reasonably, perform the agreed work in a workmanlike manner and remove its debris.

Excluded work: [DETAILS / NONE]

Permits and inspections; responsible party and cost: [DETAILS]

Target start: [__/__/____] or [EVENT]. Target completion: [__/__/____] or [EVENT]. Contractor will promptly communicate a material delay.

Total price: $[AMOUNT]. Deposit: $[AMOUNT / ZERO]. Progress payment: $[AMOUNT / ZERO] at [WORK MILESTONE]. Final payment: $[AMOUNT] at [COMPLETION AND INSPECTION CONDITION].

Payments are due at the stated milestones only when Georgia law permits them. The contractor will not require a payment from the insured while the statutory five-business-day cancellation period under O.C.G.A. § 10-1-393.12 remains open. The price does not change automatically with an insurer's estimate or payment; any change in work, price or schedule requires a written change order signed by both parties.

Emergency services, if any: [NECESSARY WORK TO PREVENT DAMAGE, PRICE OR PRICING METHOD / NONE]. The insured separately acknowledges in writing below any emergency services necessary to prevent damage before they are performed. Payment for those services may be collected when rendered as provided by § 10-1-393.12(d).

Insured's emergency-service acknowledgment and signature: [SIGNATURE / NOT APPLICABLE] Date: [__/__/____]

3. Insurance and cancellation

The insured controls the insurance claim. Contractor will neither represent nor negotiate, or offer to represent or negotiate, with the insurer on the insured's behalf about this roof work. This contract does not assign the claim or insurance proceeds to Contractor.

If the insurer gives the insured written notice that all or part of the claim or this contract is not covered, the insured may cancel by written notice to Contractor at the business address above before midnight on the fifth business day after receiving that insurer notice. A properly addressed, prepaid notice sent by U.S. mail is effective when deposited in the mail. The insured may use either detachable form below or any other written expression of intent not to be bound. Contractor will not charge a fee other than for emergency services covered by § 10-1-393.12(d) if the insured cancels under that section.

Other cancellation rights and notices, if applicable: [IDENTIFY AND ATTACH / NONE IDENTIFIED]. The statutory cancellation right above is additional to any other applicable right.

4. Completion, warranty and signatures

Contractor will provide [INSPECTION RECORDS, WARRANTY DOCUMENTS AND OTHER CLOSEOUT ITEMS] at completion. Contractor's workmanship warranty, if offered: [TERM, COVERAGE, REMEDY AND EXCLUSIONS / NONE OFFERED]. Manufacturer warranties: [IDENTIFY AND ATTACH / NONE].

The parties agree to the scope, price and terms above. Contractor confirms that it furnished the insured the statutory bold statement and both fully completed detachable notices before entering this agreement.

Insured signature: [SIGNATURE] Date and time: [__/__/____; TIME]

Contractor authorized signature: [SIGNATURE] Date and time: [__/__/____; TIME]

Contractor signer name and title: [NAME; TITLE]

Insured acknowledges receipt of both completed notices: [INITIALS; DATE AND TIME]

STATUTORY PRECONTRACT CANCELLATION STATEMENT

Furnish this statement before entering the contract. Print it in bold type of at least 10 points.

You may cancel this contract at any time before midnight on the fifth business day after you have received written notification from your insurer that all or any part of the claim or contract is not a covered loss under the insurance policy. This right to cancel is in addition to any other rights of cancellation which may be found in state or federal law or regulation. See attached notice of cancellation form for an explanation of this right

NOTICE OF CANCELLATION — DETACHABLE COPY 1

Complete the contractor name and business address before delivery. Print the notice in bold type of at least 10 points.

NOTICE OF CANCELLATION

If you are notified by your insurer that all or any part of the claim or contract is not a covered loss under the insurance policy, you may cancel the contract by mailing or delivering a signed and dated copy of this cancellation notice or any other written notice to [CONTRACTOR LEGAL NAME] at [CONTRACTOR BUSINESS ADDRESS] at any time prior to midnight on the fifth business day after you have received such notice from your insurer.

I HEREBY CANCEL THIS TRANSACTION

Date: [__/__/____] Insured’s signature: [SIGNATURE]

NOTICE OF CANCELLATION — DETACHABLE COPY 2

Complete the contractor name and business address before delivery. Print the notice in bold type of at least 10 points.

NOTICE OF CANCELLATION

If you are notified by your insurer that all or any part of the claim or contract is not a covered loss under the insurance policy, you may cancel the contract by mailing or delivering a signed and dated copy of this cancellation notice or any other written notice to [CONTRACTOR LEGAL NAME] at [CONTRACTOR BUSINESS ADDRESS] at any time prior to midnight on the fifth business day after you have received such notice from your insurer.

I HEREBY CANCEL THIS TRANSACTION

Date: [__/__/____] Insured’s signature: [SIGNATURE]

Official sources

• O.C.G.A. § 10-1-393.12, Code distribution; 2015 enrolled amendment. The official Legislative Counsel enacted-section indexes for 2023–2026 list no later amendment to this section.