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10 of Title 23, Code of Regulations, Rules and Regulations, the Texas Property & Casualty Insurance Code (the “Code”). I certify that I have inspected the property described above in my official capacity as an inspector and have written a report and signed a Certificate of Inspection and Registration. This Certificate of Investigation and Inspection Verification form is for use by the owner of the property inspected in accordance with Code provision. Please include the following information in the space provided at the top of the form. Name (Optional) Street Address City State Zip Code (Optional) Comments (Optional) In addition you may submit any necessary documentation relating to your insurance company. An inspector's signature is required. Please keep a copy of this document for your records. Please check the boxes to indicate you understand and agree to the terms of this form. I, [NAME], believe that the following information is accurate. I am an eligible owner of one or more property located in the City of Austin and the insureds listed have made me the owner of the property for which the repairs or work under this notice are being requested. The insurance company, [INSURE COMPANY], with which I have the insured or claimant to the claim is called [INSURE NAME]. I am required to submit this certificate through the Department of Insurance. I agree that any insurance company required to take responsibility will comply with this notification. Signed, [NAME] [NAME] (Optional) I am the duly authorized agent of a person, firm, company or corporation having a right to take possession of the property under the terms of this notice. This name may be changed by submitting a signed, written, notarized, affidavit to the Department of Insurance and any change of agent will be verified by the Department. I understand and agree to be liable to the insured or claimant for the costs of and expenses arising out of any repairs requested in lieu of repairs due to a wind storm, provided that the cost of and expenses referred to will be the same regardless of when the claim arises through my investigation and inspection. I, [NAME], acknowledge that my inspection did not reveal any hazardous or dangerous condition. Furthermore, I further acknowledge that the insured or respondent under a claim for insurance is entitled to possession of these materials. Furthermore, I agree that the claimant or insured under a claim for insurance may have the materials removed by one of the authorized officers provided that the claim or claim may relate to a wind storm.
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