STATE OF ___________________________
COUNTY OF__________________________

BEFORE ME, the undersigned authority, on this day personally appeared ____________________________________________, __________________________ of _______________________________, known to me to be the person whose name is subscribed to the foregoing Repair Cost Questionnaire for Builders, and having by me been first duly sworn, upon his or her oath, deposed and stated that he or she is a duly-authorized representative of the firm making the claim, and that all information provided by his or her firm in the Repair Cost Questionnaire for Builders or otherwise in support of its claim for repair costs is and will be true and complete to the best of his or her knowledge and belief.

Given under my hand and seal of office on this _____ day of ______________________, ______.

__________________________________________________________

(Notary Seal)...................................................... Notary Public, State of _________________________________________

__________________________________________________________
Printed/Typed Name of Notary

* DO NOT FORGET to include estimates for repair and photographs or a videotape of the damage to the home with this form. Any information submitted to support your claim will become the property of the Companies and will not be returned.

THIS QUESTIONNAIRE IS PROVIDED ONLY AS A GUIDE TO HELP YOU ILLUSTRATE THE EXACT NATURE OF THE CLAIMED DEFECT AND REPAIRS. YOU MAY BE REQUIRED TO PROVIDE ADDITIONAL INFORMATION TO ESTABLISH THAT HOWIC WARRANTY COVERAGE EXISTS FOR YOUR FIRM'S CLAIM. THE DEPUTY RECEIVER RESERVES THE RIGHT TO ADJUDICATE YOUR FIRM'S CLAIM FOR REPAIR COSTS IN THE MANNER HE CONSIDERS APPROPRIATE UNDER THE CIRCUMSTANCES.

Helpful Hints For Submission Of Evidence To
Verify Your Major Structural Defect Claim

The following suggestions are not mandatory requirements, but following these suggestions in preparing your evidence to be submitted to the Companies in connection with the Major Structural Defect claim may help in making a more expedient and accurate determination of your claim.

1. If you are submitting a claim regarding cracks or separation in walls, foundations, concrete slabs, ceilings, support beams, bricks, floors (including wood flooring), or cracks or separation in any other area:

A. Place a ruler over the crack before taking the picture or video.

B. Make sure when you are taking the picture or video that you are close enough to see the measurement.

C. If it is a vertical displacement crack (i.e., a crack in the floor which makes the floor unlevel), please place a ruler perpendicular to the crack to show the size of the displacement.

2. In the case of floors which are not level or walls which are not plumb (i.e., level): place a leveler on the item or show the unlevelness in some other manner before taking the picture or video.

PLEASE DISTINGUISH WHETHER ITEMS ARE EXTERIOR OR INTERIOR, IDENTIFY ROOMS WHERE DEFECTS ARE LOCATED, AND LABEL PHOTOGRAPHS WITH YOUR NAME, CLAIM NUMBER, AND WHAT THE PHOTOGRAPH DEPICTS.

THESE SUGGESTIONS ARE PROVIDED ONLY AS A GUIDE TO HELP YOU ILLUSTRATE TO US THE EXACT NATURE OF THE CLAIMED MAJOR STRUCTURAL DEFECT AND, THEREFORE, RELIANCE ON THESE SUGGESTIONS DOES NOT NECESSARILY PROVE THE EXISTENCE OF A DEFECT CLAIM. THE COMPANIES AND THE DEPUTY RECEIVER RESERVE AND RETAIN THE RIGHT TO ASSERT ANY AND ALL DEFENSES SUCH THAT NOTHING HEREIN SHALL CONSTITUTE A WAIVER OF ANY RIGHTS, SETOFFS, COUNTERCLAIMS OR OTHER REASONS FOR DENIAL OR DETERMINATION OF YOUR CLAIM AS MAY BE AVAILABLE UNDER APPLICABLE LAW AND THE CIRCUMSTANCES.

REPORT TO HOME OWNERS - Page 24