Mississippi Insurance-Funded Residential Roofing Contract

Mississippi Insurance-Funded Residential Roofing Contract

Before signing: Use this form with a currently licensed Mississippi residential builder, remodeler, or roofer that carries general liability insurance. Contractor must give the insured the attached statutory cancellation statement and two completed, easily detachable copies of the statutory cancellation notice. Print the statement and both notices in boldface type of at least 12 points. Complete the contractor, contract date, and property fields on both notice copies before delivery. This agreement does not transfer insurance rights or benefits.

1. Parties, property, and insurance

Contract date: [__/__/____]

Insured named on the property and casualty policy: [FULL LEGAL NAME]

Insured mailing address and contact: [ADDRESS; PHONE; EMAIL]

Residential roofing contractor: [LEGAL NAME AND ENTITY TYPE]

Contractor business address for cancellation: [STREET, CITY, MS ZIP]

Contractor contact: [PHONE; EMAIL]

Property to be repaired: [STREET, CITY, MS ZIP]

Dwelling: ☐ One family ☐ Two families ☐ Three families ☐ Four families ☐ Detached garage

Insurer and claim number: [INSURER; CLAIM NUMBER OR PENDING]

Claim status: ☐ Not filed ☐ Filed, pending ☐ Partly approved ☐ Approved ☐ Other: [DETAILS]

2. Work, materials, and schedule

Contractor will perform the roof work described below in compliance with applicable building codes. Contractor will obtain the permits assigned to it below, protect the work site, and remove construction debris after completion.

Excluded work: [DESCRIBE OR NONE]

Permits, inspections, and responsible party: [DETAILS]

Target start: [__/__/____] or [EVENT]. Target substantial completion: [__/__/____] or [EVENT]. The parties will document a material schedule change in writing.

3. Price and payment

Contract price: $[AMOUNT]. Insurance-funded portion expected: $[AMOUNT OR UNKNOWN]. Insured's deductible: $[AMOUNT OR UNKNOWN].

Deposit: $[AMOUNT OR ZERO], due [DATE OR EVENT]. Progress payments: [AMOUNT AND WORK MILESTONES]. Final payment: $[AMOUNT], due [COMPLETION AND INSPECTION CONDITION].

Contractor will not require any payment from the insured until the cancellation period described in the attached statement has expired. The insured remains responsible for the deductible; Contractor will not pay, waive, or rebate any part of it as an inducement to enter this agreement. An insurer's estimate or payment does not automatically change the contract price. A change in work, price, or schedule requires a signed written change order.

Work separate from or additional to insurance-covered roof repairs: [ITEMIZE EACH ITEM, PRICE, AND REASON / NONE]. The parties identify these items before signing. These items are the insured's responsibility and may be outside insurance coverage.

Emergency services, if any: [DESCRIBE IMMEDIATELY NECESSARY WORK, PRICE, AND EXPRESS PERMISSION / NONE]. An inspection or estimate alone is not emergency service. Insured's separate express permission for listed emergency services: [SIGNATURE OR NOT APPLICABLE] Date: [__/__/____].

4. Insurance communications and cancellation

The insured controls the insurance claim. Contractor may give the insured an estimate and may discuss damage and repair options with the insured or insurer. Before the insured files the claim, Contractor will not represent or negotiate the insurance claim for the owner or possessor. This agreement makes no assignment of the policy, claim, proceeds, or other insurance benefits to Contractor.

If the insurer gives the insured written notice that all or part of the claim or contracted goods and services are not covered, the insured may cancel within the period and by the method in the attached statutory statement. The insured may use either detachable notice or another similar written notice. Contractor will return payments as the statement provides.

Other cancellation right or notice applicable to this transaction: [IDENTIFY AND ATTACH, OR NONE IDENTIFIED].

5. Completion, warranty, and signatures

At completion, Contractor will provide [WARRANTY DOCUMENTS, PERMIT CLOSEOUT, AND OTHER ITEMS]. Workmanship warranty, if offered: [TERM, COVERAGE, AND REMEDY / NONE OFFERED]. Manufacturer warranty: [IDENTIFY OR NONE].

The parties agree to the work, price, and terms above. Contractor confirms delivery of the statutory statement and two completed detachable notices before the insured signed.

For a licensed Mississippi residential builder, remodeler, or roofer: complete the insurer and policy blanks below. Print this disclosure in bold, conspicuous type larger than the rest of this contract, directly above the insured's signature.

Mississippi law requires that I inform you that I DO carry general liability insurance insuring my work under this contract. The name of the insurer is [INSURER NAME], and the policy number is [POLICY NUMBER]. By your signature below, you signify your understanding and acknowledgement of this fact.

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 statement and two completed notices: [INITIALS; DATE]

STATUTORY CANCELLATION STATEMENT — ATTACH TO CONTRACT

Print the complete statement below in boldface type of at least 12 points. Give it to the insured before signing.

You may cancel this insurance benefits residential roof system repair contract at any time within three (3) business days after you have received written notice from your insurance company that all or any part of your claim, or all or part of the services and goods to be provided by this contract, is not a covered loss under your insurance policy. A notice of cancellation form is provided to you with this contract. To cancel this contract under these circumstances, sign and date, and then mail or deliver the attached Notice of Cancellation, or another similar written notice of cancellation, to the contractor within three (3) business days after you have received such written notice from your insurance company. If you cancel, any payments made under this residential roofing system repair contract, except for emergency services and repairs subsequently approved for payment by the insurance company and already performed by the contractor, will be returned to you within ten (10) business days following receipt by the contractor of your cancellation notice.

NOTICE OF CANCELLATION — DETACHABLE COPY 1

Complete the contractor name and address, contract date, and property address before delivery. Print the complete notice below in boldface type of at least 12 points.

NOTICE OF CANCELLATION

(Name and address of contractor - to be entered by contractor): [CONTRACTOR NAME AND BUSINESS ADDRESS]

(Date of contract - to be entered by contractor): [__/__/____]

(Address of residential real estate to be repaired - to be entered by contractor): [PROPERTY ADDRESS]

I have been notified by my insurance company that all or any part of my claim, or the services and goods to be provided in the residential roofing system repair contract, is not a covered loss under the insurance policy.

I HEREBY CANCEL THIS TRANSACTION

Please return my prior payments within ten (10) days.

_______________________ _______________________

INSURED'S SIGNATURE DATE

NOTICE OF CANCELLATION — DETACHABLE COPY 2

Complete the contractor name and address, contract date, and property address before delivery. Print the complete notice below in boldface type of at least 12 points.

NOTICE OF CANCELLATION

(Name and address of contractor - to be entered by contractor): [CONTRACTOR NAME AND BUSINESS ADDRESS]

(Date of contract - to be entered by contractor): [__/__/____]

(Address of residential real estate to be repaired - to be entered by contractor): [PROPERTY ADDRESS]

I have been notified by my insurance company that all or any part of my claim, or the services and goods to be provided in the residential roofing system repair contract, is not a covered loss under the insurance policy.

I HEREBY CANCEL THIS TRANSACTION

Please return my prior payments within ten (10) days.

_______________________ _______________________

INSURED'S SIGNATURE DATE

Official source

• Mississippi 2024 HB 1408, as sent to Governor, amending Miss. Code Ann. §§ 75-24-305 and 75-24-307, approved May 8, 2024, effective July 1, 2024.
• Mississippi State Board of Contractors, residential law and rules, § 73-59-11 and Rule 803-1.3.