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<br /> � '7si3+s ' �W�L'�` --- Customer Information Form—Water Damage —_ _
<br /> O I. i1�GP0YWI0CSENVI[EFpOVID[RSF0.VPP0"h o'Mrasueri�n��eratme/HumlJlryloiOryinRA�?�pis: • GumxndnmmunlVon:OmcMwSdfClnSilUtlfd
<br /> ainW�i�esytirmwnhrnerl,',p01nA$enden!ty� ' �prpminsoldryinf.w��lusecquNmenUeremove �NCVFAIotauchR��sotammvnBinn. fmlhi�
<br /> � owncd and op�nted bcJtioni nilionwke.Scrvpro �' meitNrc from tl�n ebucWre anA mntems a!ywr rcuon we rMucst yau,'umov� any sudi Ittms
<br /> IrJmltlrs, Inc Ihe lun�hi:nr may he re�ched aF fmmecrpl•i[co(hu;inerti.ThlimnvollMiMu<Gan , Immiheareaswevrdranln`,
<br /> � bCJUSLIIVPNU. ' . ... ' ol lhc rc6llvc hwuidilY tevel hdp�ndute proyeny ' � � � � ' 1
<br /> � �) ]. WONIt AUDIUIiITA�iI>N In urA r lo elu�i ovr dima�;u�nAs!mvmdd6rn Ih. � .• � . .'
<br /> • Invciry,yalwbks and HCl:loomt:Pira�e mmow �
<br /> +�Y�S�aMe Ilems Imm the ueM ue aee d.Gnfnp,
<br /> mJll�lronand�ettoraton-eii:ql mmisi6ntht • ImrgrnrytValu6lradioq: Ownra[Sf[ L'lo. . .
<br /> P telnrc thc Jo6 It sUrced.R�c arc nat FesFont0le .
<br /> � ' AbR.munfmnlnOnJmmSrrv��c�forn.in¢ai;nws rcmove.ninachwalrrus nu@IClromthealfrcteC '
<br /> P.. - Iw Ihatr flrms. �Isl anv IIcetlai Iv�hlooms of '
<br /> u[Polaleavl on im Jt t y�LYcao (Yro your 3�oi. 7r�u wlll be cem�IrlM wilh nu��pNilpe9 mp�Ilbin llnt shuulJ 6e P,Wen nua tpetial m � �
<br /> Insmance(Ov�nprihemlr ,ititm� »LI�(urv>, rabacllcicqvpmmL . � ' � rdradelicale�ma�mcntducln�herJalue. �
<br /> - InYnov�e�acllpwhatyourhwmn�ewlllmvec111i � furil�rtr Lto�rtl nnd Fllo�hcd'. A�h 4 dane Io Will di he remouin an• arsenal ll �, 3,.
<br /> �T�Illl�.11ll �O IIIIQMSIJf14 YOII��h �1�111U1I�)' Y 8 /�. /�U11 i
<br /> Lgnnsihle_lyyur_s�<Ct�Vnu� tlrdu�lihicls V���te�IrnpelrnJluniithlnpiinlhe�lleeledarra: ammunilwn;�ewMp�,valua6lrserhridnomtptlo?'
<br /> . � ryry�o�e Lebre wc s�.n wnrt.11 Inr any vamn o fimr Srr�lrr�. \Ve wi0 rherk lo�rc wh�l tyDc nt '� ���MfranNherhrginningw•aA7 . � OYON '� �
<br /> � � ' Inyuran<c<ovm�runnul4eve�AleJatthcllinro/ ' iMon �m ho:e,� OrOet�vill he-Iltled In Impttt � - 0��:� ' ____ �
<br /> . : oufcmcrQM�ysen�ite,auaJdilionalQcpositmayh� Naaring. Atmu(hw:iiermpmtihlewJl�eremovrd.'� � �e. nVCPlOORfDttEtAi.n�lbourlousupcnisms
<br /> � �e9uircd. � . . � . . o OiprlP.id�. CaJarltlAca.pon�candtxtJcwalee � ivpitt ap �wrk. Ymi rhmlA�ucumpanY Ihr'
<br /> . . U�Ic DamtCCOmwi A _'_1_� _ II Ihc P•d u nl��srd M e rei� wrtc:, II mey Lc .uprmim on Ihc Lnal vr�iA.l�muRli and EtlnC any .
<br /> �„ Ib511�ap[C�CIiC�P. � ' ��._�'��1 �_}I/�.`'u(1' N'Cf54ntp�01lTOvfllip��,plplO�tt�IFCS11AlI�pI fv:C1I0OkoA IIfNi�f cannms[o Ilre svC��µ+ofs
<br /> Ijl�� andsV�eJlheJryincV�ce::. � � auentkn. . . � . . i
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<br /> � ,-. e fa�pet farpe� wili bc dmArA lor �nloubihly, �� 7. INSUP4NCG�pIUSi[HS QII qGff:IS.N'c am ��
<br /> � . Urdutliblrlu�mvnl:_�_'� I_ __ .��Iaminallrn,vtsl�lemn!AxpdmllArw,eir. lnsome nalhrrinsuracmae�nUersnoraA<Nt:N'ev�ntwl
<br /> , . n 3. PU[OEN[E5.lhe funJ•Lec wcuN Ic D•cased k�trr damage sliii�linus,ihe appuh maY nerA�o� smhoeim anytlnng lo�6c rcPh�rd, rep�IrM or .
<br /> , . m DmNdrrelerenua uPan myu•�L ' M1e�rnmvM..Thb aan indcde tlmr rtmoval,uililnf - p+ln�rd.�f�nr�nL k In rycterve anJ prmect,slop .�
<br /> � � eeamsar,�rnc�althrc�he�d�cmnraL �mther dnnopr lu•m otturrin� and rrttore
<br /> � n �4. HOWWEPPOCE[u,lhefrar�hi�crmllattanpt ' � ' ' � �
<br /> � lo 'picitrve .�nA p;nkcl" yun' sbucbne anU �.Lc�lm�•nb: Our �imecsa� ma�� Iq�IULr Ne . N�m.iged Ilem: m Meir prio: miwlittao when
<br /> ' a�plicatiaaolFVrbregktneEditiNe.bnle . P�+s:b!e � � �
<br /> . mNe�u.1tM tollowing steyi may bc wmDkted In . . . , . � � ' � ��
<br /> 'the rmnR�'���Y sence, a� delsrrrvnrd tn� Le o t�uipment Oryirif equ'�pmunt wip be Wcd Io Ory � �' 10. FMERGFNCY CM�pGES. ihe en t p�i[c nl
<br /> applrtabic6y�he forchlvre. . - ynut proMrly.Thr pwpou ol lhn r�ulprtso;li�o msmrinp,your VNCc�ry(ollvulnf.M'aler dainagn�5 i
<br /> � rtmovo moislu�c nrJ Aring thc relalNc humld�ry �'nuJ1�yimpo'sMemArlcrmmcondurlinfY,tiLA I
<br /> e curvey Ihe 41en1 0l Damapr and Imprct iM verhal hdrll wi:l M
<br /> - - Crrmitrtc Our Inillil invprtllon M ihc premiat h <<`TI back to nom�al, II is Impnrtant Ihc equipmcnt � �fO�""�"�to you ar your
<br /> i � 6e FeO� running,�unluv a eAhry ha�ard aiius. ��sunmm�Apiaer.lhesmprofwdrkeanNan�e �
<br /> �tslp,ried lu kentlly hoai murA damagc h�� . . . . . dce 10 uNoiesem tLcum�tances.Yhc pm161i1 w111 �
<br /> .. � tt�ouraanEplinihen^ttnaryem�rR��rywm�. . . � V�esslvcmahiurccan511116eymrntemnwAmall •
<br /> N�iLle iadaie�veem dry,wMJi m�y Irad�o muld be b�wmled m you and/or yom m�ur.+ntt amdcr �
<br /> . .. ihc Impaciron i5 alro dune ler solcry rwson:..Wc � � u�wr.romplcllon. � "
<br /> anrc4 thc aHnled ar�a,lar LaEJlaDdn¢; cciLnp � N�a+ihnfolherdanuE�� �'�'rwlllmonUa�uwichm , � ' �
<br /> �� � � . Aam�N�,.iS�bWelcatrlca�Iqurdi.u�menlstlamaC�, , Mwetmatetl.ik - � � ' U n,NENTN IW� SAfCtt. M1lilntalninr your� -
<br /> ' walladhuaLmrddam.�y�,uda�rvrahqvisbk • �uuu:al:Mymlutel�rmssathascarpetpadwlllM � P�Ronalhralihen.. :aleh�iofR�eatamicemtnu5.
<br /> � malJ.ctc .' � . �o�nnYrdanAA��I�sivlolp�upedy. . .. All�rrupanisandpi9sihmdditayJwJYfmmlhc
<br /> � f.�r � - ' . , . �4a.rastiiprnteR�hdrhea4handsaletYdu�in�
<br /> ynu aWarc ol any polcnlial salety h�fmtli In Ihe O� 5.� YINnT IS It6TOPBA�[, Uateer�IninN r�auly Ihe wm4 O�a�e!i.A1ar.rial Salciy D�i+SI;�Ms for
<br /> . ��IrurlumT . OY011- �vhatnnberevaduntil'c�ivl�'nplsdrVlinsvaliy ourproEurkucavadabL:vpoqvqvest.
<br /> . � Idemify Sourte / ryn� oLlYatre Co�L�mLolcd�� �.���V�ssib!e W�will sri a lollow�up dalc io we t�n f�pnm�r. In i.rt�in moldt may.cauu hivllh
<br /> � . waler sourco�lile�ovagq em.rrc�+e spdidGmd mmllo� 11 n drying.p•p�rs� In adA11 nn, thc pmhlmnt. If you havc any mnhms,you shWIC �
<br /> ����e�loretion pro[et<ct In adllGen, 1hc eduico ol �ntnrallon.p�mcsv rvlll hr sdreduleA when Ihn ' �ontullaphysitlan: � '
<br /> . aa:rnhouhtbc�om�'elelynu�yiedptlorlostaninq � diNnR,�h rnmplNr. ihk� c�n Indedr Iloor Ilyou�lr.ircntl&tionalinlmmaiion,plrucer�ua�
<br /> an�wm4 oQi¢i tlian Oiv RRoval prrcns.�� - ' p�^parallnn,tark slnD rcolammc t rarpet anJ p.M �
<br /> � � � � � i ��� � . � � ih^SfHViqO Mold Lro�here;and mnt.ui yout .
<br /> . . � ' scurrenlwmrrinms�o�.(._utiti� F:'(� C!r . � In+lalUlion,eeminf..u�pctrlp�nn;;ind�ritmin¢. � IorzImSL�telmahhdrp�tlment. • ' .
<br /> .. . ?bsihrsnuuenfwatenc�enstop�rd7 OYON :mA fumllnre apA.ronlrnN dranmq, n tmV� of . � , . . �
<br /> scrvkesw�llhepinuidrd. � Ilas.�Y^�clnlhn3liU�lclen�petlen[edhatliona�.
<br /> � IMn1�lyNSILIrMnldfmwikllklmputl.nlfo�iv . . ' . . toihewalorinl�uticn7 OYON
<br /> lo Mnow whelhrr v�siLlc muld grow1A Is prosanL �� �'' ��LfX6iINfi �oR; pgflOSS (O�pITI0N5.� " �� � �
<br /> . . Duiing Ilm ruur,c nl d��anlnC.wr vA!I Lfrll'Femnvr �o Y���haoc anY Le..ilh conarm�ayuut lhc waler�..
<br /> � . IYbIIemMA:mayArfounilinsmplla�nnunl++lmotl Inlw�Jon7 ' � OYON �
<br /> ' . auywhmc,lary•crR��r+.th�ofmalAmaynmlchrellh daVlodaVsolling,whld�eei�IrAPibridVoorin:�. . . . .
<br /> ' cm�trm:,tlrprndn�I.��nlhrrcxninnolan.upanLm �VrereLapt�Ymdnw.lf.hAvicvrr,l�crrmowlnl WoulAWul0.r.mpirv� 1rM.OS7 . OYUN
<br /> ' � muld. rye.evistinFsnllre9uim�sl�nillcanleqraetlnrt.oiu O I2.nPP1�OMiMI�,1CCG: '��[ilON: lucaclualtlme
<br /> ' � ' ' vewswillbeimtrvclttllomnvcunln�hene'Clt�m. �rq�icd la camplcle Ilm �n�oqllon r
<br /> . , Ilave you sriv;gm f�nlA g�rn.ln�;anywhr�e I�i ' � p oee�� Is
<br /> . . Pire�klinP damaC�.indudmY.��siltc muld 6�owIA; Ain�A1 lo c�llnute. We�rallma�evppmviiwirly
<br /> ' Ihestnrhnrnrl�sr t.nl i. 'OY.U11 vnllal�obrnnleA. . ' �
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<br /> Seenmolrlg�oMholanyllmclnUxy��li UYUN Ilas �hr slru�twc sv5tah�cA Icalt m �wler . . ' . '� . .
<br /> fiollcrA�nY�Aoiwtmu5lYsmrlfs7 OVON InlmvinptlntheV�•.t7 nYnN III4VCPCAf1ANDUND[NST�NDTNfAUW[�. .
<br /> ' � • S�minlimrl pmmdurci am mqvired Inr m�lcrlals � � �� ' STp7FMINI3�NI11NlaPMRI0NC0,YfpIK[DHtqflry,"
<br /> . Q ). PIRSON4liiCpiS.�ln IIIC munc o( ou� ,MYONSWFNSTOTIICIIpOVf,QVESTIONS�RE
<br /> � , L4n:ulA,leeJralnl,asLeslm,UdnesedM��II.Mc .«�ryey and_clpaning, wc will 5omctlmc5 he� � ACWPATEARDCOMVlC1I.�
<br /> I(cr mticc a ti�aifcant preirnm al Ihr�e types of . . . ' . .
<br /> ' rnai�tlaH,nrEellevet�� �hal#eliluotllhnsuch /eqNredtooycpdoor5,cupbnJrdi,rlclnqualily . �u�!omeNartw �1, f ,
<br /> ' +nd/of �esmm thc danjaBr II you yrAc� m 1``1��`��� ��'��'�
<br /> . m��crlab e�itl in lhe slrtirturc,uc vnll nollM��� � rtusmmerSls�+�u�e // � � '//� � T� /'
<br /> InwlvcJ pm�ics sa' Ihey may drteiminr �n �emm�c personal items and prrionxl or.linandal � =-o �-7-�_� --��'v
<br /> � Inlaiina0on from thesc areas�6dore wc stan, ���dr/ss nalme� � �� ,�I.
<br /> . appmptlaUcaursenlanian., .. ' � ._ , �C _ly. ._;T__
<br /> plrasc Ict us Anow. � 't I .-i 1 �I'� � .
<br /> /�e luu ae�ic of anY ma�rrLds In thc sim<lu�e � . � , . .Oale - _
<br /> pfilalun9hlreyNn:ipedafrrdcleannpp�rciAdret � . � . .. ' � �
<br /> . Imold.leadValni,asFedm,fhinrnedm+rll,ei�17. � � . .�. .fmnchi�elcyalNamr. � � ���� (��:2� .
<br /> ' UYON . � . � ... ' . �/b/a1fP1PPOnf '. In �� ,���i ��d.i��l� .
<br /> ' (�15FNVPRO'IN1ELlERUAIPROPFRN,Ina�, � � . AILHIGNTS�PkSFRVED� PG�051707I.0� ' 7R501 01/]I.
<br /> . AaAS6�RVPHO°/�imirlriv i�lnAqmndnillyO�rmrl nrtdOprmlrA�
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