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Ins. Carrier:
Print Name Owner/Agent:
Print Name Owner/Agent:
Owner Contact#: 22-M?
)~mail Address: 4M rx
l olicy Number: 3 D.
This Agreement made by and between Onshore
Owner(s)/Agents, hereinaftercalled the "Owner".
hereby acknowledged, hereby agrees.as follows:
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Roofing Inc., .hereinafter called the "Contractor" and the abovemm aed
Contractor and Owner, for the: consideration named herein, the sufftcieticy
1, the Owner/Agent for the job site listed. below, authorize Onshore Roofing, Inc. `to ;inspect my property for: wind: damage/lift,
missing roof components, potential leak areas, and furnish necessary.materials, performall, labotnecessary to preserve and
protect my property from further damage.
AUTHORIZED ENE, RGENCY RE, PAIRS: I order the Assignee to;perform emergency:repairs and/or betterments to the
property as follow
Tarp: CaulldSeal: Dehumidifier: .. . Fans:Oust.Debr'is: Remove Free: Patch:
lelieve, and understand that in the best'ud mentof Assig nee .these services are likely needed to ttgiigate further loss or damage
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to the property. To the extent I made any payments for these services to Assignee,. I retain .only the right to seek, reimbursement
under the insurance policy,
The Owner is hiring Contractor to perform a replacementof the roof and all other repairs on the property, damaged,.as, a result of.
a casualty/loss suffered by Owner, which is covered by Owner's .Insurance Policy::• By executing this Agreement, Owner
authorizes Contractor to prepare a proposed Scope of Work reflecting all necessary repairs related to :the damages, using :industry
standard scoping & pricing data (the "Work"). C
Assignment. Owner hereby assigns. any and all insurance rights; benefits, and' proceeds under any applicable insurance policies
relating to the above -;referenced casualty/loss to Contractor or services; rendered or to>be rendered by Assignee. Owner makes this
,assignment inconsideration of Contractor'.s'agreemerit to perform servi' .supply materials, assess damages to the roof and other
areas of the home; and otherwise perform. its obligations under its contract with Owner; including Contractor not requiring fully
payment at the time of service. Owner intends to transfer all insurance eights to Contractor, including any causes:of action which
exist or may exist in the future relating to the'aboYe-referenced casualty/loss. OWner unequivocally direct.my insurance carriers)
to release any and .all information.requested by Assignee, its representative, and/or its attorney for the purpose of.,obtaming post -
loss insurance benefits for services rendered or to: be rendered.
I, Owner, understand that any portion of work, deductible(s), betterment; depreciation, or additional work requested by me, or
otherwise not covered by insurance,'is ultimately my responsibility. If T rescind this agreement, then 1 agree, too promptly pay
Assignee for all contracted work performed.
S'T01FwORK - HOLD HARMIXSS: In the event Assignee is not allowed.to perform its recommended.proc..dures emergency
repairs, to prevent further damage to the property, then I agree to release and hold Assignee harmless, and indemnify. Assignee
against all claims or actions that may result from.such inaction. Assignee shall. provide: a copy . ttl s executed agreement to the
insurer within three (3.) business days after the agreement is executed or the,date on which work begins, whichever ik earlier.
liabilities, damages, losses; and costs,' including, but not limited
Assignee shalt indemnify and hold harmless Assignorfrom all
to, attorney's fees, should the policy subject to the assignment agreement prohibit, in whole or in part, the assignment of benefits.
If I want to rescind this agreement, I must provide a signed written notice of rescission to Assignee during the time period
identified in 18-0oint uppercase and boldfaced type on the reverse of this •document. h understand that any ;portion of work;'
deductible(s), bettennent, depreciation,. or additional work requested by me, or otherwise not covered by insurance, .is ultimately
my responsibility. If Trescind this :agreeement, then T agree o prom. ptly. pay Assignee for all :contracted work performed.
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YOU -AIDE AGREEING TO DIVE UP CERTAIN RIGHTS YOU HAVE UNDER YOUR IBSURkNCE
POLICY TO A THIRD PANTY, WHICH MAY RESULT IN LITIGATION AGAINST YUUR
INSURER. PLEASE READ AND UNDERSTAND THIS DOCUMENT BEFORE SIGNING IT. YOU
HAVE THE RIGHT TO CANCEL THIS AGREEMENT WITHOUT PENALTY WITHIN 14 DAYS
ALTER Till DATE THIS AGREEMENT IS EXECUTED AT LEAST 30 DAYS AFTER THE DATE
CORK UN THE PISUPERTY IS SCHEDULED TD OIAMENCE IF THE ASSIGNEE HAS NOT
SUBSTANTIALLY PERFORMED, OR AT LEAST SD DAYS AFTER THE EXECUTID OF THE
ASREEMFN IF THE AGREEMENT DOES NOT CONTAIN A COMMENCEMENT DATE AND THE.
ASSIGNEE HAS NUT HEGUI N SUBSTANTIAL ORK ON THE PROW, HOWEVE10 YDU
ARE OBLIGATED FOP PAYMENT UE ANY CONTRACTED � HRK PERFORMED OEFUI�E THE
AGRERvIENT IS RESCINDED. THIS AG EEMEIHT DUES HUT GHANDE YOUR OBLIGATION
TO PERFORM THE DUTIES REQUIRED RIDER YOUR PRUEMY INSURANUE POLICY.
General Provisions:
i.This document is the-fdll Agreementbetween Owner and Contractor;: regardless of any prior proposals or communicafions�ond I"s. subject to
approval by your insurance company of, Seope.of Work and Price. Contractor will not"be obligated to, perform any work:absent agreement.
with your Insurance Company,
il.Contractor will maintain Workers' .Compensation. covermg:its':employees, as well. as. Cleixeral �,tatiihty Insurance; as required by law.
iii.Owner. shall provide suitable access to the work area. If Contractor's Work;is dapendent:ripori ormustbe undertaken in conjunction;tivithahe
work 'of others, such work shall be so performed add completed as to permit Contractor to perform its work :hereunder in a normal
uninterrupted single shift operation:
iv.Final payment of all work performed hereunder shall. be made upon issuance of a Certificato ofOccupancy by. the building department or
upon passing final inspection by the building department;Np punch Fist work:shall,be performed until Contractor h, as received Final'Payment..
v.Attorney's Fees and Costs: If any action. is brought arising out :of or.:related-to this Agreement between'the parties to this Agreement, the
prevailing party shall ber entitled to reasonable attgMey's:fees (at.ali levels), posts, .and necessary disbursements in addition to any other
relief to which it may be entitled:.
vwispute Resolution: Any claim, dispute; or other. matter in question out of or related co this Agreement or the Work provided,hereunder
shall be f led in a Court of competent jurisdiction `and shall be tried before a•: Judge or. a. Confidential Binding Arbitratibp whichever the.
Contractor prefers. The parties hereby waive their right to,a trial by jury.
vii. Wnue anal Choice of Law: The'parties;agree that venue for any.actl n arising put of this Agreementor performance.hereunder, must be
in Martin County, .Florida to the exclusion of all other places. This. Agreement is..govemed and willbe interpreted ig accordance with.
Florida Law.
bill. If after the Work has been completed and paid in full, including suppiements, additions addlor Contractor's: Overhead and Profit allotted
for the roof, the Owner.or Contractor should want, to ierrhiiiate Its coritractual obligations to the other they max do so with no penalties,
ix. Owner agrees to assist Contractor :in obtaining..payment from the Insurance .Company by providing all necessary docunielits •ieaSonably
required by Contractor and/or 'Irisuranee• Company and by executing; any additionaldocuments reasonablyret(uired Fry .Contractor and/or
Insurance Company to make the payri ents to Contractor.
x. This Agrcement,constitutes the entire agreement and understanding between:,the parties and supersedes all prior communrcadons, written,
and oral. This.Agreetrient. may be amended only by written instrument signed -by both parties.
Direct Payment Authorization. I hereby' authorize and unequivocally demand direct payment of any: benefits or proceeds. for services
rendered by Contractor to be rmade,payable solely to Conte ctor and shall bo:delivered directly and exclusively to Contractor; Ilwe agree that
any portion of wo�lc,. deductible, betterment, depreciation, or additional work requested byme; .or :otherwise. not covered by insurance, is
ultimately my responsibility.
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dame aaitee on Material and Workmanship. All materials are.guaranteed to.lie:as specified 'in the warran, ty provided, by the manufacturer's
warranty. The installation is guaranteed to be performed;in accordance with thepennits.approved.by the mun 'c.ipal authority having jurisdiction
over the Work for two. years from the date of substantial completion. However, no warranty, will. be:provided: for damaged caused to the Work
by ordinary wear and tear, lack of adequate maintenance, or acts of god; hicfluding hurricanes, totnadoe"s; and the: hike
Changes in Scope of Work. Any change in the Scope of Workspecificalty requested by bwner.or required by p, lan reviewers; city inspections;
and county or state building/planning departments involving extra costs: ("Additional Wor'.k.") will be performed: by Contractor.and-will become
an extra charge over and:above the Total Price..Also,.Additional Worlcmay be required if concealed conditions are.discovered after work has
commenced which require work beyond the work described in the Scope,of Work. Contractor may, at its,discretion, stop work until the parties
execute a Change Order describing the additional'work and the costfor'sarne, In the event that.. additional work is porformed and a change
order between the parties was not extra. work will be charged on a time andmaterlalbasis, plus _"/o for,Centractor's proftt •and overhead
expenses. The cost of.the Additional. Work will be added fo.ahe outstanding balance; to be paid iy Owner and/or Insurance Company:
Notes and Exemptions:' Owner acktiowiedges that.delays to the progress. of the Work can he caused, by events oiut;of Contractor's control,
including,but not limited to delays in permit processing;:inspections. material shortages, unavailability of qualifiedworkers, and severe weather
events. Contractor shall not be liable for any failure to undertake or compWe'the Work withima particular time.. Contractor -may suspend.,the.
Work for nonpayment and, for causes beyond its control, including but:not;limited to fire, flood or•other casualtnthe presence on or beneath.
the work site of utilities, facilities,.substances,-or objects, including biit=not limited to any substance that is hazardous or toxic or the reporting;
remediation, or clean -.up of which is re
quired"by and law or regulation (together "subsurface conditions'?); labor disputes or other disagreements
and accidents or other mishaps, whether affecting this work of. other operations in which Contractor is iirpoived directly or indkoctly.'No
claim for damages shall be made or as against the Con tractor'by reason. of any delays, disruptions, oHifterference.
! ltrrve reed stall yrtderstararGlfae'i►aforinntdnaa tliroaaela t/ris llaree13) %naee tloccu►reiad and have receiyed:rt coDy:tar ng, records.
Signs re Owner/Agent
Signature Owner/Agent
Onshore Roofing, Inc.
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Date.
'Date
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