524 75TH ST SE 2020-01-21 - Laserfiche WebLink

SERVPRQ' Authorizat�=o Perform Services and Direction of }ment Customer Name: Terrace at Beverly Lake-Roof Repair Date of Loss: Loss Address: 524-75th St. SE Everett City: State: WA Zip: 98203 an P Y N/A Insurance Com Claim Number(if available): N/A The undersigned Customer, being the building owner, owner's representative, or resident, authorizes the Provider identified below to perform any and all necessary cleaning and/or restoration services on Customer's property located at the property address above, and with respect to items that need to be cleaned at a remote location to remove and clean such items as necessary. Customer authorizes N/A Insurance Company, herein referred to as"Insurance Company,"to •pay Provider solely and directly for that portion of the work covered by Customer's insurance policy. If,for any reason, Customer receives a check from Insurance Company made payable to Customer, Customer agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Customer hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Customer's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Customer agrees to pay Customer's deductible in the amount of$ N/A that applies to this claim. If any amounts owing to Provider for Provider services are not covered by insurance, Customer agrees to pay those amounts to Provider within fifteen (15) days of Customer's receipt of invoice. It is fully understood that Customer and its agents, successors, assigns, and heirs are personally responsible for any and all deductibles and any costs not covered by insurance. Interest and finance charges will be charged at the maximum allowable by law, or at 1.5%per month, whichever is less, on accounts over thirty(30)days past due.Time is of the essence. Customer agrees that Provider is working for the Customer and not Customer's insurance company or any agent/adjuster. Property Owned By: Terrace at Beverly Lake-Roof Repair 1-year warranty Remarks: Job total$6,582.00 per attached scope.Affected portion of roofing to be repaired, not the entire roof. I HAVE READ THIS AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT, INCLUDING THE TERMS AND CONDITIONS OF SERVICE ON THE NEXT PAGE HEREOF, AND AGREE TO SAME. Customer Reviewed Custome Inform- ion For : ®Y 0 N Provider's Signature: nterprisesI , nc. Customer's Signature: .:.iii , ` Franchise Legal Name: l ' ._ errace at Beverly Lake-Roof Repair North Everett/Lake Stevens/Mc Printed Name: d/b/a SERVPRO®of: Date: L')_1/2(?11 Date: l SERVPES871RD E-mail Address: Contractor License#: ©SERVPRO"INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1.0 28000 08/14 Each SEI?I7'RO" Pranrlr/s,'is Independendy Owned and Operated.