Building Repair Estimate

Date
Claim or
Policy No.
Home
Phone
Bus. Ph.
Insurance amount
Unit cost or
material price only
Unit
Total
Unit
Price
(Col A)

Insured
Loss Address
City
Bldg. R.C.V.
Bldg. A.C.V.
Insurance required
R.C.V. (
%) A.C.V. (
%)

Description of Item

This is not an order to repair

Page
of
Cause of
Loss
Other Ins.
Y

Labor price only

Hours

Rate

Totals

The undersigned agrees to complete and

guarantee repairs at a total of $
Repairer

Total Column A

Street
City

Phone

By
Adjuster

Date of A/P

Adj. license no. (if any)

Grand Total

Service office name

Note: This form does not replace the need for field notes, sketches and measurements

Total
(Col B)