￼ Authorization & Notice to Insurance Company
Date of Loss:__________________________________________________
Type of Loss:_______________________________________________________________________Claim#:_____________________________
The Undersigned / Insured (or insured’s authorized representative) hereby retains the General Contractor LGT Restoration Services Inc. (to be referenced from here and throughout as LGT) remediate, repair or replace the said damaged property and charge the total costs of said repairs to the referenced owner and insurance company/carrier.
The Adjuster of said loss is hereby authorized and instructed to attach A copy of this completed form to “Proof of Loss” and to make LGT as an interested party to the claim of the insured in consideration of making said remediation, repairs or replacements.
Insurance company (or companies) liable for the coverage under the said loss is hereby authorized and instructed to pay LGT the just and total costs for said remediation, repairs, or replacements. Deductible (if applicable) is said to be paid by the property owner / policyholder.
Conditions of Proposal and Contract:
1/ Materials: Unless otherwise specified, contractor shall have the right to select all materials.
Contractor will make reasonable attempts to coordinate with the owner party as to the type and color of material to be replaced or repaired.
2/ Change Orders/Additional Work: Any alterations to the original estimate scope, (including reduction of work), will be agreed upon by both parties. Costs will be paid in full by property owner and to be paid as scheduled, and due in full upon completion. Any additional Supplements will be paid to ____ including all “Code Upgrades” and “Unseen / Subsequent Damages”. (see #3)
3/ Supplements to Insurance Company: In the event that there are additional repairs needed due to unseen conditions, ____ will submit a supplemental claim / estimate to the insurance company for the cost of additional repairs that were found to be necessary. ____ shall be paid in full for any supplemental claims not covered by the insurance company.
4/ Unavoidable Interruptions: Contractor shall not be liable for any causes beyond its control.
5/ After payment of claim to insured, and in the event of cancellation of this agreement by the insured a 25% fee will be paid to LGT Restoration Services, Inc. for coordination and settlement of claim.
6/ The agreement to perform repairs or construction does not include any labor or materials not specifically mentioned in the estimate or scope of repairs. Any items not covered in the scope of repairs and performed by the contractor will be considered a Change Order / Additional Work and be treated as outlined in #2 above.
7/ Prices for materials and labor associated with this agreement are good from 30 days of the above referenced date. After 30 days the contractor has the option to review material and labor prices, and submit a new estimate to the insurance company for any changes in the market.
8/ Deductible (if applicable) is to be paid by the owner.
9/ Warranties and “Release of Lien” will be given after ALL payments are made in Full, and total balance is paid in FULL. Partial release of liens will be available for third party payment release.
10/ If a dispute arises out of this contract and such dispute cannot be settled through direct negotiations between the parties. The parties agree that any process of law necessary by the contractor to collect any balance due that the insured will be liable and agrees to pay all cost related to such process.
11/ Homeowner agrees that the agreed upon work will be completed by _____ in a timely manor. As with all major construction / remediation projects undertaken by a inhabited property owner, some property damage shall occur. Driveway / parking, shrubbery, lawns, vehicles, underground utilities, pools, and eaves / sides of property are especially vulnerable to damage during a major construction project. Property owner has the responsibility to secure any interior objects, pictures, decorations and / or valuables. Any attic area or exposed area below the roof will receive debris, and should be covered by property owner. All exposed ceilings should expect roofing nails to protrude. The contractor and insurance company shall not be liable for any damages outlined above and to include water intrusion during the completion and duration of the work performed.
12/ Soffit / Fascia, Metal Work / Copings, Flashing, re-pointing etc… work is not included with any roofing project unless specifically written into the contract and paid for by the property
owner or by the insurance company.
First Insurance Check Down
Additional Payment Terms:_________________________________________________________________________________________________________
Property Owner Signature(s):