Contingency

Agreement

I/We the owner of the property located at:

Agree to retain/hire National Home Improvements of New York, Inc., here forth known as (NHI-NY) to represent me/us in obtaining my/our insurance companys approval for the repair and/or replacement of my/our damaged property. If we are unable to get homeowners insurance to pay for the needed repairs, then the homeowner shall have no liability to (NHI-NY). I/we empower (NHY-NY) to contact my/our insurance carrier and meet their adjusters/representatives and discuss damages and replacement work to be done on my/our property in order to negotiate the funds needed to make the necessary repairs and/or replacements. 1) After negotiation is completed with my/our insurance carrier as to the extent of the damages and the total cost of repairs, I/we give (NHI-NY) the exclusive right to do the repairs to the subject property as payment for their help in obtaining insurance approval. I/we agree to pay (NHI-NY) for the total cost of repairs including supplemental funds from the insurance company. A written (NHI-NY) Work Order must be completed and signed before scheduling or work will be performed. All insurance checks must be endorsed and made payable to (NHI-NY). All work done by (NHI-NY) will be performed in accordance with the insurance companys damage/scope of work specifications summary. I/we agree to retain (NHI-NY) as my/our exclusive contractor until the repairs and/or replacements are completed and the insurance company has released any and/or all depreciation and supplemental funds to (NHI-NY).

2)

3)

Insured Name: Email: Date:

Insured Address: Insured Phone:

Insurance Co. Name: Insurance Co. Phone:

Policy#: Email:

Claim#: Date: Date:

Insured/Property Owner Signature: Insured/Property Owner Signature: NHINY/Representative Name:

Signature:

Phone: (516)322.2651 Fax: (516) 908.4239 Address: 388 Jackson Ave. West Hempstead, NY 11552 Licenses: City of New York 1422066 Suffolk County 49326-H City of Long Beach 5817, County of Nassau 0305740000