Broward 954-981-7852 ota Springs: 299-092 Gade sceowoe7 All Hours Emergency Water Removal, Inc. Novas Qu: 388282 2778 Went Be: SE1-885 0254 Carpet Sales - Repairs - Restretching - Restoration Tol roe BFF sen ee FL Myers: 299-481-0080 ‘6428 N.W. 26th Lane - Margate, FL 33063, 386.7427 island: | wateriere@ecloon Peers eee DRYING CONTRACT AND ASSIGNMENT en OF INSURANCE BENEFITS Date of Contract: evo SS nt Contras How did you learn about our company?. alla ease ain rent INSURED: INSURANCE CO. Bropeibia atlel mcer ibe petted ee ee ALL HOURS EMERGENCY WATER REMOVAL, INC. and INSURED named above agree that: ALL HOURS EMERGENCY WATER REMOVAL, INC. UNDERTAKES TO: 1. Provide emergency services as required to mitigate damage. 2, Provide a detailed BILL to be submitted to the INSURANCE COMPANY named above, 3. Deal direct with the ADJUSTER representing the INSURANCE COMPANY named above, INSURED HEREBY: 4 _Uindertakes to provide access to the property and grants ALL HOURS EMERGENCY WATER REMOVAL, INC. first right of refusal on the restoration work. 5. Authorizes direct payment (or co-payment) by the INSURANCE COMPANY to ALL HOURS EMERGENCY WATER REMOVAL, INC. for all services rendered. © _Undertakes to cooperate with ALL HOURS EMERGENCY WATER REMOVAL, INC. to ensure that payment 's made by the INSURANCE COMPANY immediately upon completion of the work. 7. Acknowledges that the incidences of Default and Remedies for Default on the 2nd page, forms an integral Part of this document. 8. Declares that he/she is the owner of the property at which work will be performed or that he/she is the ‘owner's representative legally authorized to contract such work. 8. Acknowledges that any introduction or referral of ALL HOURS EMERGENCY WATER REMOVAL, INC. by the INSURANCE COMPANY to the INSURED does not make the INSURANCE COMPANY a party to this contract. 10. Acknowledges and agrees that ALL HOURS EMERGENCY WATER REMOVAL, INC. was invited to present is emergency services contract and that itis not a solicitation as defined by Florida Statute, Chapter 501. 11, ALL HOURS EMERGENCY WATER REMOVAL, INC. has advised me that my insurance company may not reimburse me. | understand that | am responsible for charges not paid by my Insurance carrier. In the Event of sult for collection, reasonable attorney's fees and collection costs will be added to this invoice. In {he event of any tigation arising from this contract, proper venue shall be in Broward County, Florida, This contract between ALL HOURS EMERGENCY WATER REMOVAL, INC. and the insured/property ‘owner or agent includes this Drying Contract. 12. Acknowledges that a detailed billing using Xactimate pricing for day drying estimate in the amount of $ will be attached to this drying contract and assignment of insurance Benefits. f additional days are needed to obtain our drying goal beyond the intial estimate, we will then use Page 2 of this contract. Remember by looking, touching or feeling - this does not mean itis dry. tis only dry when moisture meters indicate itis dry. x a ee Homeowner / Authorized Representative Date All Hours Emergency Water Removal, Inc. Date Page 1 of 7 WHITE - ALL HOURS EMERGENCY WATER REMOVAL, INC. - YELLOW. HOMEOWNER + PINK- INSURANCEPrnae So Seh ese All Hours Emergency Water Removal, Inc, Roan Quant: 252020078 West Boos: 881-999-0254 Carpet Sales - Repairs - Restretching - Restoration Tei eiee errs Myers: 29064-0088 6428 NW. 28h Lane Marat, FL 3 : Marc ald: 239°360:9097 Ses eae raaes Ema wattnere@asl oon DRYING CONTRACT AND ASSIGNMENT OF INSURANCE BENEFITS Date of Contract a eta LSU ola ue eee a ets Cold INSURANCE BENEFITS FOR CONTINUATION OF RESTORATION INSURED: INSURANCE CO.: Property at which work will be performed: ALL HOURS EMERGENCY WATER REMOVAL, INC. and INSURED named above agree that: ALL HOURS EMERGENCY WATER REMOVAL, INC. UNDERTAKES TO: 1. Provide emergency services as required to mitigate damage. 2. Provide a detailed BILL to be submitted to the INSURANCE COMPANY named above. 3. _ Deal direct with the ADJUSTER representing the INSURANCE COMPANY named above. INSURED HEREBY: 4 _Uindertakes to provide access to the property and grants ALL HOURS EMERGENCY WATER REMOVAL, ING. first right of refusal on the restoration work Wuarenzes direct payment (or co-payment) by the INSURANCE COMPANY to ALL HOURS EMERGENCY WATER REMOVAL, INC. for all services rendered. 8. __Undertakes to cooperate with ALL HOURS EMERGENCY WATER REMOVAL, ING. to ensure that payment 's made by the INSURANCE COMPANY immediately upon completion of the work. 7. Acknowledges that the incidences of Default and Remedies for Default on the 2nd Page, forms an integral Part of this document. 8 Declares that he/she is the owner ofthe property at which work will be performed or that he/she is the ‘owner's representative legally authorized to contract such work. 8. Acknowledges that any introduction or referral of ALL HOURS EMERGENCY WATER REMOVAL, INC. by Tee toy RANCE COMPANY to the INSURED does not make the INSURANCE COMPANY a party to this contract. 10. Acknowledges and agrees that ALL HOURS EMERGENCY WATER REMOVAL, INC. was invited to present Bon Meraeney services contract and that it is nota solicitation as defined by Florida Statute, Chaptor 501 1h AUP HOURS EMERGENCY WATER REMOVAL, INC. has advised me that my insurance company may not reimburse me. | understand that | am responsible for charges not paid by my insurance carrier in th of suit for collection, reasonable attorney's fees and collection costs will be added to this invoice, In she event of any litigation arising from this contract, proper venue shall bein Broward County, Floris, This contract between ALL. HOURS EMERGENCY WATER REMOVAL, INC. and the insured/property' ‘Owner or agent includes this Drying Contract. 12, Acknowledges that a detailed billing using Xactimate pricing for this day drying estimate in the amount of § will be attached to this drying contract and assignment of tri ance Benefits. If additional days are needed to obtain our drying goal beyond the intial estimate, we will then use Page 2 of this contract. Remember by looking, touching or feeling - this does not mean fo dry. Itis only dry when moisture meters indicate itis dry. ene ee Homeowner / Authorized Representative Date All Hours Emergency Water Removal, Inc. Date PINK - INSURANCE Page 2 of 7 WHITE - ALL HOURS EMERGENCY WATER REMOVAL, INC. + YELLOW- HOMEOWNERBroward: 954.941-7052 Bonita Springs: 299.292.0778 Doce: 205-940-2447 All Hours Emergency Water Removal, Inc. North Caroina Beararis West faim: S61 697-9596 Carpet Sales - Repairs - Restretching - Restorati 0.2008 Marco Island: 289-980.0057 (6428 N.W. 26th Lane - Margate, FL 33063, Fax: 954-956-7427 Email: wiafreniere@aol.com es ALL HOURS EMERGENCY WATER REMOVAL, INC. is entitled to Emergency Service Call as | oS sontacted ALL HOURS EMERGENCY WATER REMOVAL, INC, and | was informed of the cost of the Emergency Service Call from the beginning. ALL HOURS EMERGENCY WATER REMOVAL, INC. is NOT entitled to Emergency Service Call, as they initiated contact with me. have not been scared or intimidated with any statements regarding mold of any sort | understand All Hours Emergency Water Removal will not be liable for any mold, mildew, fungus or dry rot. paogeet that ALL HOURS EMERGENCY WATER REMOVAL, INC. pricing will not exceed Xactimate pricing and | have been informed by ALL HOURS EMERGENCY WATER REMOVAL, INC. this was accepted and ordered by the Attorney General's office of the State of Florida. {will make available access to the property being restored so monitoring and moisture readings can be performed to prove to myself and my Insurance Carrier that the equipment on the job is needed for each day it is on the job. |'understand that if additional days are required from the First Estimate, a Supplemental Written Estimate will Need to be signed with the estimated price to proceed with the Dry-out Process. {understand that in the best judgement of ALL HOURS EMERGENCY WATER REMOVAL, INC., all wet materials Should be treated with a commercial antimicrobial agent to inhibit the growth of microorganisms during the crying process. | have received oral and writen information regarding the antimicrobial agent and agree that all Wet materials should be treated with this product as part of the restoration process. | understand that it is Beyond the expertise of ALL HOURS EMERGENCY WATER REMOVAL, INC. to determine if someone may be Sensitive to its application and will hold ALL HOURS EMERGENCY WATER REMOVAL, INC. harmless for ts, use. The liability of ALL HOURS EMERGENCY WATER REMOVAL, INC. is expressly limited to the total amount of the Services authorized herein and in no event shall ALL HOURS EMERGENCY WATER REMOVAL, INC., ts agents 1 assigns: be liable for consequential damages of any kind, ALL HOURS EMERGENCY WATER REMOVAL, ING. has advised me that my insurance company may not reimburse me. In the event any legal proceedings must be instituted to recover the amount due, ALL HOURS EMERGENCY WATER REMOVAL. INC. shall be Entitled to recover the cost of collection including reasonable attorney's fees. In the event of any litigation arising out of this work, proper venue shall be in Broward County, Florida, 1, (Name) (Position) Do hereby give my consent for ALL HOURS EMERGENCY WATER REMOVAL, ING. to video and voice record events and conversations pertaining to this restoration job. Page 5 of 7 WHITE - ALL HOURS EMERGENCY WATER REMOVAL, INC. - YELLOW- HOMEOWNER + PINK- INSURANCEBroward: 954.941-79¢ ase Seer Serassossz All Hours Emergency Water Removal, Inc. Norm Shaina 2228 978 aes Sat 83.0284 Was Pai Seatr aes Carpet Sales - Repairs - Restretching - Restoration ‘Bice gr ee: Marv shane Sees es ‘6428 N.W. 28th Lane - Margate, FL 33063 ae SS. 7527 Emait wiareiere@ecl ee — NAME: DATE / LOSS: ADDRESS: PHONE: CELL: INSURANCE COMPANY: ADJUSTER'S NAME: PHONE: FAX: CLAIM NUMBER: ROOMS AFFECTED: WATER EXTRACTION: Sq/Ft: IAI et nea ee cigs Sq/Ft: AIR MOVERS: UNITS: ___ DAYS: DEHUMIDIFIERS: UNWTS:_—""__ Bays: MOVING CONTENTS: MEN HOURS: MOISTURE INSPECTIONS: % DATE(S): (See attached report) DECONTAMINATION: UNITS: Page 6 of 7 WHITE - ALL HOURS EMERGENCY WATER REMOVAL, INC. + YELLOW-HOMEOWNER - PINK. INSURANCEBrowars: 954-041-7052 Bonita Springs: 230-092.0770 Boos sergiozse” All Hours Emergency Water Removal, Inc. fen Sarina seeraa7i3 Wast Palm: 861 697-9696 Carpet Sales - Repairs - Restretching - Restoration ‘ 77-260 2008 Mars EE 5 a8 me 6428 N25 Lane Margate, FL 39008 emai ie oases at i MOISTURE INSPECTION Customer: DATE/TIME | ROOM LOCATION READING RH. TEMP, INITIAL EQUIPMENT AMOUNT | DATEIN | DATE OUT INITIAL, DRYERS VENTS VORTEX DEHUM. OTHER Customer requests: Technician's notes: Page 7 of 7 WHITE - ALL HOURS EMERGENCY WATER REMOVAL, INC. + YELLOW-HOMEOWNER + PINK- INSURANCE