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Post Warranty Alteration Form
Date:
FBPCO #:
Building Identification:
Building Address:
Owner:
Contractor Name:
Contractor License #:
PV Manufacturer:
Warranty #:
Expiration Date:
PV Installation Date:
Type of Post Warranty Alteration:
General Roof Alterations
Garden Roof System
Photovoltaic Installation
Thank you for your notice of alterations to the Warranted Firestone roof assembly on the above
referenced building. Under our current procedures and conditions, all attempts must be made to involve
the original installing contractor to make the necessary repairs. Only currently licensed Firestone
contractors will be allowed to perform alterations on a warranted roof system. A Post-Warranty Alterations
(PWA) inspection of the roof may be required by Warranty Services upon review of the submitted
documents. Firestone will require the following information to be submitted in order to update the existing
Firestone warranted project and in order for the existing warranty to remain in full force:
**Alterations over $10,000.00**
YES
NO
General Alterations or Garden Roof only:
I certify the following is attached to this document: (Please be sure all boxes are checked.)
Firestone license number and name of contractor to perform work
Before and After photos clearly showing scope of work performed
Submit description of work performed including all flashing and/or other details to be used
Roof Drawing indicating location of Alterations or Additions
Photovoltaic (PV) projects only:
Once the PV system has been installed, a Post-Warranty Alteration inspection may be required after
review of the submitted documents and completion photos at the discretion of QBS Warranty Services
Department. A pre-installation inspection of the roof is not required. The PWA inspection verifies only that
new flashings or other alterations to the warranted roofing system were installed in accordance with
Firestone technical standards and details.
I certify the following information is attached to this document: (Please be sure all boxes are checked.)
Name of PV Manufacturer
PV Install start Date
Drawing to include proposed PV layout and Roof Plan
Proposed protection/slip sheet materials
Overburden waiver completed and signed by the Building Owner ONLY
PV rack manufacturer’s detail drawing for the installed PV system.
**All alterations over $10,000 will require an inspection by a Firestone Representative**
The charge for the required inspection is $750.00 payable to Firestone. No payments will be accepted
prior to submission of a Firestone invoice. The invoice will be directed to the owner listed on the
warranty unless a third party company is responsible for payment and has included separate billing
information. The purpose of the inspection is for verification of new membrane flashings or other
membrane related alterations only and to ensure compliance to Firestone written recommendations for
repairs.
Name of Submitter:
Representative of (Company):
Date:
Email:
Upon successful review of the completed work and receipt of the content of this form, the existing
warranty will remain in full force. Failure to follow the procedures outlined in this document, including
failing to notify Firestone, may disrupt your warranty coverage on this project. Firestone has the right to
rely on the information submitted with this form, and submittal of this form is authorization for Firestone to
review the submitted material. The person submitting this form has requisite power and authority to
submit the information and make the request(s) in this form.
** Please submit this form and all required documentation and photos to andersonjay@qbsg.net ** FAILURE TO FOLLOW THESE PROCEDURES OUTLINED ABOVE, INCLUDING NON‐NOTIFICATION TO FIRESTONE, MAY DISRUPT YOUR WARRANTY COVERAGE.
250 West 96th Street – Indianapolis, IN 46260
1-800-428-4442 * 1-317-575-7000 * FAX 1-317-575-7100
www.firestonebp.com
02242015