This form is to be utilized in accordance with NCGS 143-143.7 Elevator safety requirements for certain residential rental accommodations
“Upon installation of a door baffle, door space guard, door, or gate meeting the requirements of the law, the landlord shall provide the Commissioner of Insurance with one of the following:
(1) A statement signed by a professional elevator installer certifying installation of the door baffle, door space guard, door, or gate meeting the requirements of the law.
(2) A receipt for purchase of the door baffle, door space guard, door, or gate meeting the requirements of the law, a signed statement by the landlord stating the date of installation, and photographs depicting the door baffle, door space guard, door, or gate as installed.”