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INDEPENDENT ROOFING COMPANY

Residential & Commercial


6102 Arbor Street, Suite 5 ● Omaha, NE 68106 ● Phone 402.585.5702 ● Fax 402.400.8846

AGREEMENT
This Agreement Is Subject To Insurance Company Approval
Name: Date:
Address: City / State:
Billing Address: City / State:
Home Phone # Work Phone #

SPECIFICATIONS SPECIAL INSTRUCTIONS


□ Grade of Shingle
□ Style of Shingle
□ Color of Shingle
□ Ridge Material
□ Valley
□ Vents Power vent
□ Plumbing Stacks
□ Metal Edging
□ Tear Off: Y N
□ Felt Turbines
□ Pitch Stories
□ Remove trash from roof, gutters and yard
□ Protect landscaping where applicable
□ Roll yard and driveway with a magnetic roller

COMPANY'S LIMITED WARRANTY


One Year on Replacement & Repairs

SPECIAL ATTENTION AREAS


□ Skylights Y N □ Cover Y N
□ Stucco Damage Y N □ Driveway Damage Y N
□ AC Damage Y N □ Emergency Repair Y N
□ Screen Door Damage Y N □ Chimney
□ Shutter Damage Y N □ Leaks
□ Deck Damage Y N □ Interior Damage

Homeowner acknowledges that Independent Roofing Company will be entitled to __________% overhead and __________% profit,
O & P, if allowed by insurance company.

Insurance/Mortgage Company Note: I hereby authorize the insurance and/or mortgage company below to make any checks jointly.

Terms: This agreement does not obligate the homeowner of Independent Roofing Company in any way unless it is approved by the
insurance company and accepted by Independent Roofing Company. When "price agreeable" is determined it shall become the
final contract price of $___________ and the homeowner authorizes Independent Roofing Company to obtain labor and material in
accordance with the "price agreement" and the specifications set out herein and on the reverse side hereof to accomplish the
replacement or repair.

Accepted by Homeowner on: Date By

Payment Method: Pay Upon Completion of Each Trade By


Insurance Co.: Claim #
Mortgage Co.: Account #
Address: City / State: Zip:
Field Supervisor: Management Approval:
Both sides of this document, including the terms and conditions below, and any agreement executed in writing, made pursuant
thereto, between Independent Roofing Company ("the Company") and the property owner(s) or property owner(s) representative(s)
, hereby referred to as the "customer", are subject to the laws in effect in the State in which it has been
signed and executed.

ANY REPRESENTATION, STATEMENTS, OR OTHER COMMUNICATIONS NOT WRITTEN IN THE CONTRACT,


OR MADE IN WRITING PURSUANT THERETO, ARE AGREEDTO BE INVALID, AND NOT RELIED ON BY
EITHER PARTY AND DON NOT SURVIVE THE EXECUTION OF THIS CONTRACT.

1. This contract is subject to the credit and pricing approval of the management of Independent Roofing Company.
2. Payment is due for materials when delivered. Payment is due for the remainder of the contract with the completion of each
individual trade. We will issue a Certificate of Substantial Completion when we have completed the scope of the contract.
In the event a final inspection is required before the "Customer" chooses to pay, the "Customer" shall agree to pay the total
balance due, less ten percent (10%) as hold back until the final inspection and any subsequent punch list is completed.
3. Should default be made in payment of this contract, a lien will be placed on the property and charges will be added from the
date of substantial completion at the maximum allowed by law. If placed in the hands of any attorney for collection, all
attorney and legal fees will be paid by the "Customer". Nebraska: Any person or company supplying labor or materials for
this improvement to your property may file a lien against your property if that person or company is not paid for the
contribution.
4. The "Company" and the "Customer" agree to settle all disputes through the American Arbitration Association.
5. The full amount of all monies as specified by the agreed price, or, as specified by "Full Scope of Insurance Proceeds", does
not include extras such as carpentry repairs, or any other repairs not specified, and not covered by the "Full Scope of
Insurance Proceeds", that is necessary to complete the repair process as required by local building codes, and,
building officials, or to satisfy cosmetically, the "Customer".
6. If a "Customer" chooses not to pay for a part of the scope of the contract, an individual line item or a trade, the "Customer"
releases the "Company" of it's obligations for the performance of that component with regard to the integrity of the building
systems as a whole.
7. The "Company" is not responsible for damage below the roof due to leaks caused by excessive wind greater than 55 m.p.h.,
ice or hail, at any time during the construction process, or the warranty period. (Note: not responsible for nail protrusions
during construction process).
8. The "Company" will not be responsible for slight scratching and denting of gutters, oil droplets in driveways, hairline
fractures in concrete, flowers, or minor broken branches on plants and shrubbery.
9. This contract can be canceled any time prior to midnight on the third business day after the date of this agreement.
10. This contract cannot be canceled once negotiations begin with your insurance company, and or material has been delivered
to your job site without written mutual agreement of both parties.
11. If this contract is canceled by the "Customer" later than (3) days from execution, "Customer" agrees to pay "Company" 25%
of the contract price for: 1. Consulting service rendered, or 2. Liquidating Fees. If materials have to be returned due to this
cancellation, the "Customer" agrees to pay an additional fee of 10% for restocking.
12. The "Company" reserves the right to supplement the insurance company for increases in the "Full Scope of Work", and or
documented price increases. "Customer" agrees to allow these supplements to be paid directly to the "Company".
13. All excess materials remain property of the "Company".
14. "Full Scope of the Insurance Proceeds" shall be defined as the full price for repairs and replacements allowed by the Insurance
Company.
15. If any provisions of this contract should b held invalid or unenforceable, the validity and enforceability of the remaining
provisions shall not be affected thereby.

WARRANTY
OUR STANDARD WORKMANSHIP WARRANTY IS FOR ONE YEAR. WE WILL PROVIDE YOU A WRITTEN
WARRANTY UPON RECEIVING YOUR PAYMENT IN FULL FOR THIS CONTRACT. COPIES ARE AVAILABLE
FOR YOUR PERUSAL.

16. We shall not honor our warranty on contracts that are not paid in full.

PLEASE MAKE CHECKS PAYABLE TO INDEPENDENT ROOFING COMPANY


Customer's Initials