Bulldog Adjusters, INC.

499 NW 70th Ave Suite 114

Plantation, FL 33317

Phone 877-737-7764 Fax 877-772-0392

Claims@bulldogadjusters.com

The undersigned (the Insured) hereby retains the above Public Insurance Adjuster, Bulldog Adjusters Inc (the PA) to be the Insured's representative in the adjustment of the above-referenced loss under the following terms:

The Insured hereby agrees to pay to the Public Adjuster (PA) an amount equal to {nonemergencyPa} {emergencyPa}% of the gross amount of the collected loss or damage recovered regardless of whether the loss is settled or paid by the insurance company or by reason of the above-referenced policy as a result of adjustment, mediation, appraisal, arbitration, lawsuit or otherwise, on all coverage applicable under the referenced policy or any other applicable policy, including, without limitation, bad faith (hereafter referred to as the "PA fee"). If no recovery is made, the Insured will not be indebted to the PA for any sum of fees. This paragraph does not apply to additional living expenses which is subject to a separate agreement.

The Insured hereby authorizes the PA to contact the above-named insurance company to direct them to include the name of Bulldog Adjusters, Inc. as a payee on any and all insurance proceeds checks issued by reason of the above-referenced loss. This provision shall remain in full force and effect unless revoked by mutual written agreement of the insured and PA.

All risk and/or damage inspections are to be coordinated with and through the PA. The Insured has instructed and hereby instructs all insurance companies and authorized the PA to direct insurance companies to provide PA/Insured with the following within ten (10) days from notice for each policy of insurance (including, but not limited to, coverage forms, amendatory endorsements, and/or exclusions) that may in any way provide coverage for the subject loss: (1) certified copy of each of the policy(ies), including the declaration page and any applicable exclusions, endorsements, etc; (2) the type and limits of the coverages afforded by each policy; and (3) a statement of any policy or coverage defense that the insurer reasonably believes is available to such insurer at the time of filing such statement for each policy. It is requested that the insurance company ensure that all policy provisions are complied with in processing the Insured’s claim. Please note that it is the Insured’s intention to make a claim for loss and/or damage relating to any replacement cost provisions of the policy of insurance. Further, the insurance company must immediately send to PA and Insured any additional or supplemental documentation or information that may be discovered in the future relating to this request.

If during the pendency of this Agreement and/or Letter of Representation PA determines within its sole discretion that the Insured can no longer be represented for any reason, PA may withdraw from further representation through written communication to the address listed above.

You, the insured, may cancel this contract for any reason without penalty or obligation to you within 10 days after the date of this contract by providing notice to Bulldog Adjusters, 499 NW 70th Ave Suite 114, Plantation, FL 33317, submitted in writing and sent by certified mail, return receipt requested, or other form of mailing that provides proof thereof, at the address specified in the contract.

In the event that this Agreement/Letter of Representation is canceled by the Insured after ten days, then the PA shall have a retaining lien and charging lien for work performed and costs advanced, and entitled to their entire fee. Furthermore, the PA will not be held liable in any way for any filed claims on the property which were canceled by the Insured.

Payment to the PA shall be due and payable in full at the time that insurance proceeds are paid or issued by the insurance company. In consideration for the PA's professional services, the Insured by this agreement hereby irrevocably assigns to the PA, and the PA shall have a lien on, the portion of the insurance proceeds paid or payable sufficient to pay the amount due the PA under the agreement. In the event legal proceedings are brought by the PA to enforce this agreement, the prevailing party shall be entitled to recover its court costs and reasonable attorney’s fee, including those of any appellate proceedings. Venue for all legal proceedings to be held in the courts of Broward County, Florida.

The Insured hereby authorizes the PA to hire the professional services of appraisers, umpires, estimators, engineers, and any other experts as may be deemed necessary by the PA. Any costs associated with said claims recovery will be reimbursed to the PA. The Insured must consent to the cost prior to the PA hiring said professional(s). The Insured understands that it is responsible to pay the PA its fee, out of any and all insurance proceeds, prior to any payments to anyone else, including but not limited to mortgage companies, insurance companies, lenders, creditors, or any third parties, of any kind, or any other individual or corporation. The Insured hereby agrees that the Insured is solely responsible to timely obtain any and all mortgage endorsements necessary of said payments/checks so as to release payments to the PA. The PA shall in no event be obligated to conform to mortgage company requirements, in order to receive agreed to fee payments, and or out of pocket reimbursements.

The Insured acknowledges that the PA has made no guarantees regarding the disposition or results of any stage of the claims process and all expressions made on behalf of the PA are the opinion of the PA based on information known at that time.

Unenforceability or invalidity of one or more clauses in this Agreement shall not have an effect on any other clause in this Agreement. If it is possible, any unenforceable or invalid clause in this Agreement shall be modified to show the original intention of the parties.

The Insured represents that all information given to the PA is true and accurate. The Insured understands that pursuant to S.817.234, Florida statutes, any person who, with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost or repair of damaged property in support of a claim under an insurance policy, knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete or misleading information concerning any fact or thing, material to the claim, commits a felony of the third degree, punishable as provided in S.775.082, S.775.803, or S.775.084, Florida statutes. The Insured understands that the PA relies on the information provided by the Insured.

Remember to click "CONTINUE" at the end of this agreement before closing this page.

Recuerde seleccionar "CONTINUE" al final de este acuerdo antes de cerrar la página.

I agree to retain and compensate the public adjuster for adjusting my additional living expenses and securing payment from my insurer for amounts attributable to additional living expenses payable under the policy issued on my {Home}

The Insured hereby agrees to pay to the Public Adjuster (PA) an amount equal to {nonemergencyPa83} {emergencyPa84} % of the gross amount of the collected loss or damage recovered from additional living expenses (Coverage D) regardless of whether the loss is settled or paid by the insurance company or by reason of the above referenced policy as a result of adjustment, mediation, appraisal, arbitration, lawsuit or otherwise, on all coverage applicable under the referenced policy or any other applicable policy, including, without limitation, claims for bad faith and extra-contractual damages or loss (hereafter referred to as the "PA fee"). If no recovery is made, the Insured will not be indebted to the Public Adjuster (PA) for any sum of fees.

STATE OF FLORIDA:
who, after being duly sworn, acknowledged to and before me and swears and attests to the following: {insuredName91}

I am over the age of 18.
I am a named insured for the policy written by: {insuranceCompany93}
I hereby attest that I have the authority to enter into the contract with my public adjuster: {adjusterName99}
I hereby attest that I have the authority to settle all claim issues on behalf of all named insureds on this policy.
Under penalty of perjury, I declare that I have read the foregoing document and that the facts stated are true to the best of my knowledge and belief. 
FURTHER AFFIANT SAYETH NAUGHT.

Pursuant to Fla. Stat. 92.525, Under penalties of perjury, I declare that I have read the foregoing DECLARATION/AFFIDAVIT OF INSURED and that the facts stated in it are true.