Apex Estimate Request Form (ERF v.2025)

• Your Email:*
Careful with the spelling -- this is the field that will be used to send you a confirmation of receival email.
• Your first name and shortened company name:*
• Is this a FIELD-based estimate or a REMOTE/DESK-based estimate? In other words, is an on-site field inspection required to complete this estimate?

On-Site Inspection: A field visit to the property will be neededRemote Desk Estimate: This is a 'desk-based' remote assignment and I will provide the information to complete the estimateOther
How many loss Incidents are we addressing at this property? (Please submit 1 request per-loss) - Loss Incident #1
Loss Incident #1 - With Brief Description of Loss Cause/Reason
Loss Incident #2 (If Applicable)
Loss Incident #2 - With Brief Description of Loss Cause/Reason
Loss Incident #3 (If Applicable)
Loss Incident #3 - With Brief Description of Loss Cause/Reason
If home has multiple loss incidents:

We need to know each loss and the damage associated with it. This also prepares us to receive additional forms and organize them and set the time aside accordingly. Of course, each loss incident will have it's own designated claim #, policy #, type/date of loss, cause of loss, etc --- not to mention the fact that certain losses require certain instruments, and we want to be prepared for anything.
• Type of Estimate(s) Requested (Check all that apply):*

Water MitigationCat. III/Sewage Water LossTarp ApplicationFire/Smoke/Soot Cleaning &/or RebuildRebuild/ReconstructionMold RemediationMicrobial Testing/Assesssment AssignmentAppraisal AssignmentOther
• To help us know how much time to set aside for this assignment while in the field, are you able to identify how much damage we will be needing to scope out/document?

SmallMediumLargeExtra-LargeGinormousOther
• Who should we contact to coordinate the appointment?

Me (the person filling out this form)Coordinate directly with the homeownerCoordinate with the tenant/renter of the propertyOther
• Would you like to be present during estimate field inspection?

YesNoOther
• Name of your Client you want on coverpage of estimate & short description of type of loss next to it:*
• Letter & numbers ONLY - This is the official name that will go on the coverpage of the estimate. This is usually the homeowner, insured, business, or policyholder name. This is NOT the name of you or your company.
• Street Address of Property:*
• City, State, Zip:*
• Building/Unit # & Community Name:
• Mobile Phone # of Your Client or Contact:*
Please also list any tenant or other contact info that we may need
• Date of Loss:

MonthDayYear
• Insurance Carrier Name:
• Claim #:
• Policy #:
• Type of Loss:
• If 'Water Loss', please state what *type* of water loss, such as appliance, plumbing supply line, drain line, HVAC, etc.
• Should a deductible be applied to the estimate? If so, how much?
If you'd like us to apply a deductible to your estimate, please enter it here.
• Estimated Amount of Damages $:
• If you have an estimated dollar-figure of what you think this estimate will arrive at, please list it here. This question usually pertains to contractors as this helps to give us an idea of how large the anticipated scope of work will be.
• Components to be included in estimate:

Roof - Full replacementKitchen - Cabinetry / countertop replacement (or partial)Bathroom(s) - One or more bathroom(s) to be fully replaced (Shower/vanity/tile walls/etc.)Tile Floor(s) - Full tile flooring replacement throughout all continuous areasExterior Elevations, exterior paint, patio, pool enclosures, soffits, fencing, etc.Other
• Bills, Invoices, Receipts, &/or Proposals:
• Please tell us, if any, bills, invoices, receipts, &/or proposals to include in the estimate. Remember to include the total amounts and what company they come from.
• Scope of Work Notes & Other Assignment Notes:
• Provide a basic idea what this estimate will consist of; list any/all areas, continuous areas, matching areas, etc. that you'd like us to include in the estimate. For example, if you'd like the roof to be included in the estimate, please mention that. The more specific you are, the faster & better your estimate with turn out. On the other hand, if you'd like to leave that up to us, that is fine as well.
· Please Note:

If you have attached a large amount of files to this form, it may take 10 seconds or longer for the submittal to go through, depending upon your network speed. Please remain on this page until you've received a confirmation dialogue. Thank you!
· File Upload Section ·

Click button above to upload pertinent files, videos, photos, and other documents that will assist us in building as accurately as possible. Please do not include irrelevant information. Any uploaded photos WILL BE included in the estimate. If you do not wish some photos/files be included within the estimate, please make a note of that in the "Notes" section above.
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Water Mitigation/Mold Remediation Section

Information Needed To Build An Accurate "Time & Materials" Estimate
· Pro-Tip:

The better, more clear and concise information we get, the better, more accurate and professional estimate we are able to create. We work with the material supplied to us. Make sure it's neat and organized, as it will only help you in the end. Thank you.
Is this a PROPOSAL or INVOICE?

Proposal/Bid (Job has not been completed yet)Invoice (Job has been completed)Other
Pricing style:

Xactimate-ONLY pricing - Only use current Xactimate-database prices for itemsI would like to use 'Custom Unit Pricing'. (Please enter custom pricing in chart below)
What do you approximate this estimate should be around, dollar-wise? If you don't know, put "N/A":
This is helpful and will give us an idea of where you are anticipating the total of your estimate to be at/around.
If this was an emergency service call, did the initial call take place DURING or AFTER business hours?

During Business HoursAfter Business Hours
Apply debris removal fee to this invoice or proposal?

YesNo

· Technician/Crew Labor Hours Chart:

Rows	# of Technicians	# of Hours Per Tech	# of AFTER Hours Per Tech
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10

· Other labor-related notes:

· Machines, Equipment & Supplies Needed:

Rows	How many	How many days ea	# of Filters	Custom Pricing Per Ea
Dehumidifiers
Air Movers
InjectiDry
Air Scrubbers
Hydroxyl Machine

· Other Materials:

Rows	Qty/Amount	Custom Pricing Per Ea. $
Contents Packout - How many boxes?
ULV Fogging - per cubic Ft.
Anti-microbial spray - per sq. ft.
Encapsulation - per sq. ft.
Containment Barrier(s) - per sq. ft.
How many zippers used
Sq. ft. of floor protection
Sq. ft. of contents cover/protect
# of Garbage bags
# of PPE's (Personal Protective Equipment)

· HVAC Cleaning & Decontamination:

Air handler onlyDuct system onlyAir handler & duct systemNone/Does not apply
· # of Ducts Cleaned/Treated:
· Apply infra-red camera charge/moisture detection/evaluation fee?

YesNo

· Mold Testing Charge:

Rows	Amount $
Pre-Test $
Post-Test $

· Tarp Application:

Rows	Amount
Tarp (Poly Tarp) Size (IE: 20x30)
Shrink-Wrap Tarp Total sq. ft:
# of Sandbags Used
# of wood strip battens
How many hours did the tarp application take?

**You have completed this section. Please scroll back up and click the 'submit' button. Thank you!
Should be Empty:

If home has multiple loss incidents:

· Please Note:

Water Mitigation/Mold Remediation Section

· Pro-Tip:

**You have completed this section. Please scroll back up and click the 'submit' button. Thank you!