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Emergency Work Authorization
This form authorizes 1-800-RESTORE to perform emergency work and necessary services at the address below
Insured Name
*
First Name
Last Name
Claim Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Insurer
Please select your project manager
The Work:
Tear out and emergency work as necessary
Equipment setup as necessary
Clean & Disinfect if necessary
Is there additional work to add? (PM use only)
Yes
Additional Work
(for Project Manager Use only)
Terms and Conditions
The Customer warrants and represents that no further consent or authorization is required to permit 1-800-RESTORE to enter the Property and perform the Work
The Customer shall be responsible for verifying insurance coverage, deductible(s), GST/HST on commercial insurance claims and all other particulars. TheCustomer shall be liable to 1-800-RESTORE for the charges incurred pursuant to this Work Authorization regardless of any denial of coverage by the Insurer. Any cheques issued by the Insurer in respect of the Work shall be endorsed by the Customer to 1-800-RESTORE
If the Customer does not make payment within 30 days of the date of the invoice(s), the Customer agrees to pay the 1-800-RESTORE an interest rate of 12% per annum on any unpaid amount calculated from the date upon which such amount was due and payable until the date of payment in full.
1-800-RESTORE shall perform the Work as soon as reasonably practicable and shall do so in a good and workmanlike manner in accordance with industrystandards and as may be directed by the Adjuster/Insurer. No other expressed or implied warranty or guarantee shall apply to the Work
1-800-RESTORE shall be compensated for performing the Work based on 1-800-RESTORE’s standard labour and material charges including applicable contractor’sfees, plus applicable GST/HST as and when invoiced by 1-800-RESTORE. 1-800-RESTORE’s standard charges are available on request
1-800-RESTORE is authorized to collect, use and disclose personal information regarding the Customer for the purposes of performing the Work and in doing so 1-800-RESTORE shall comply with all applicable legislation including the Personal Information Protection Act [SBC 2003]
In no event shall 1-800-RESTORE be liable for any delay or damages arising from events or circumstances beyond its immediate control including, without limitation, any failure of or interruption in telephone or other communication systems, a breakdown or malfunction in equipment, labour disputes, unavailability or shortage of materials, parts or other commodities or an order or directive of a judicial or public authority.
The Customer herby authorizes and directs the Insurance Company to make payment directly to the Company for the work approved by the Insurer.
Name of Signee
*
First Name
Last Name
Signature
*
on behalf of owner for address given above
Submit
Should be Empty: