Emergency Mitigation and Rebuild Work Authorization

Client Name______________________________ Property Address__________________________ ________________________________________ Phone___________________________________ Client e-mail______________________________

This authorization is made on the above date by and between _______________________ thereinafter referred to as Restoration Services of Traverse City, and the Client named above, to proceed with its recommended restoration procedures to restore the above property and its contents to a pre-damaged condition. By initialing here, I am allowing Restoration Services of Traverse City to set drying equipment and to do any necessary deconstruction as approved by the IICRC S500-1999 Water Damage Restoration Standards. Initials____________ Date_______________ I understand I will receive a five year limited extended warranty on all construction repair work performed by Rockford Restoration upon satisfactory completion of work, execution of the Certificate of Completion, and payment in full. Additionally, I understand Restoration Services of Traverse City agrees to perform all work for an amount approved by my insurer and I will not be required to pay any amount other than my deductible of __________ unless otherwise agreed upon in writing prior to starting that portion of repairs. I understand my insurance company is not recommending or requiring I use the services of this or any contractor and I have the right to use any contractor I choose. By initialing here I am allowing Restoration Services of Traverse City A Notice of Commencement to begin the reconstruction process. Initials____________ Date________________
The liability of Restoration Services of Traverse City is expressly limited to the total amount of the services authorized and in no event shall Restoration Services of Traverse City, its agents or assigns, be liable for consequential damages of any kind. All disputes arising out of this agreement shall be determined by arbitration in accordance with the rules of the American Arbitration Association. The decision of the arbitrator shall be binding and judgment upon the award may be entered in any court having jurisdiction. In the event any legal proceedings must be instituted to recover the amount due, Restoration Services of Traverse City shall be entitled to recover the cost of collection including reasonable attorneys fees. My insurance carrier ___________________ is hereby authorized and directed to include the name of Restoration Services of Traverse City on payment drafts. In the event of payment being issued without the name of Restoration Services of Traverse City on the insurance draft, it is MY RESPONSIBILITY to ensure Restoration Services of Traverse City receives payment in full once repairs are completed. I agree payment will be made immediately upon completion of work. I understand I am responsible to pay my insurance deductible. Non- payment of any portion will result in 1.5% interest monthly from date of work completion and any legal collection costs.

Cause of Loss____________________________ Insurance Company_______________________ Adjuster________________________________ Adjuster Ph._____________________________

Authorized Signature______________________________ Printed Name____________________________________ Date___________________________________________

Restoration Services of Traverse City Signature_____________________________ Printed_______________________________