Eagle Eye Roofing Insurance Loss Report

Incident Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Insurer Name*

First NameLastname

Primary Insurer Email*

example@example.com

Primary Insurer Phone*

Please enter a valid phone number.

Secondary Insurer Name

First NameLastname

Secondary Insurer Email

example@example.com

Secondary Insurer Phone

Please enter a valid phone number.

Adjuster Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Policy #

Claim #*

Insurance Company*

Insurance Phone*

Please enter a valid phone number.

Agent

Agent Phone

Please enter a valid phone number.

Roof Inspection (check all that apply)

	Not Satisfied
3 Tab
Laminated
Metal Roof
2 Layers
Hip/Ridge Cap
Ridge Cents
Turtle Vents
Pitch Charge
Height Charge
Chimney
Flue Caps
Antenna
Pipe Jacks
Valley Metal
Step Flashing
Apron Flashing
Sky Light
Poower Vent

Gutter Inspection (check all that apply in dropdown)

	Front	Left	Rear	Right
Gutters
Spouts
Screen Guards

What Type of Material

VinylAluminumWood

Color

Size in Inches

Type a question

GarageShedOther

Miscellaneous/ Notes

Contingency Agreement

Terms: I understand that Eagle Eye Roofing LLC will invest time, resources, and expertise in assisting me with this insurance claim. This agreement is contingent upon the insurance company paying for the repairs and will be void if the insurance company disallows the claim. I agree to let Eagle Eye Roofing LLC do the work for the full replacement cost. Ealge Eye Roofing LLC will negotiate with my insurance company to set the price of the claim. The only out-of-pocket expense I may incur is my deductible of $___________. I will provide Eagle Eye Roofing LLC with a full set of copies of my insurance paperwork, including Xactimate. I understand that I am able to cancel within 3 days of signing, with no penalty. I understand that Eagle Eye Roofing LLC is entitled to all overhead and profit.

Deductable amount

Primary Insurer Signature*

Date*

Date

Secondary Insurer Signature

Date

Roof Rep Name*

First NameLast Name

Roof Rep Email*

example@example.com

Roofing Rep Signature

Date

This agreement was made between Eagle Eye Roofing, LLC and/or the insured, herein referred to as "insured".
Eagle Eye Roofing, LLC Standards of Industry. WARRANTY TO INSURED:

The warranty on roofing is 10 years from when the contract is executed, an upgrade of 15-20yr is available. The warranty on siding is 10 years from when the contract is executed.

The warranty on gutters and downspouts is one year from which the contract is executed. The warranty on all other repairs is one year from which the contract is executed.

CLEAN UP JOB SITE:

The job site dumpster or trailer will be located on the insured property. The location of such equipment will be directed by the homeowner. Eagle Eye Roofing, LLC shall not be used without their consent.

Lawn rakes, shovels, and brooms will be used to ensure satisfactory cleanup. Magnetic pickup devices will be used to remove nails and scrap pieces of metal.

CONTINGENCY AND GUIDES

1) THIS AGREEMENT IS VOID IF THE CLAIM IS DENIED BY THE INSURANCE COMPANY. In the event that the claim is denied, but later approved upon re-inspection or supplement by the insurance company, this agreement is still binding.

3-DAY CANCELLATION PERIOD. You have the right to cancel this agreement within 3 business days of the date on the face of this document. You must send a copy of the Notice of Rescission dated on or before the 3-day period. Send notice of Rescission to Eagle Eye Roofing, LLC. 428 Edison St NW, Uniontown, OH 44685.
Upon a re-inspecting and claim approval, if the insured cancels this will result in a charge not to exceed 25% of the total claim amount.
As your insurance claim specialist, the start of work is considered when Eagle Eye Roofing, LLC meets your adjuster and begins negotiation on behalf of the insured. Once work is commenced, the 3-day rescission period will immediately expire.
All contracts are subject to approval by Eagle Eye Roofing, LLC. Payment terms, as well as the scope of work and additional work trade-offs, are subject to approval by management.
Should a default of payment arrangements occur, Eagle Eye Roofing, LLC may add late charges at 1.5% per month.
Eagle Eye Roofing, LLC assumes no responsibility for damage caused by rain, wind, hail, tornado, fire, or any other Act Of God, not covered at the original date of loss. Eagle Eye Roofing, LLC Reserves commercial liability insurance to cover "at fault" losses, not to exceed $2,000.00.
The cost of replacing rotted decking at $50.00 a sheet, 1x6-12 decking at $6 per If, fascia or any other building defects should not be absorbed by Eagle Eye Roofing, LLC. The insured may agree upon trade-offs in the insurance company's scope of work in order to offset the cost of some/all of these items.
This proposal will expire in 90 days. Eagle Eye Roofing, LLC reserves the right to reprise this estimate, as the pricing from the insurance company's estimating program may change quarterly and the price of the building materials may increase. There shall be no out-of-pocket absorbed by the insured due to the price increase.
Eagle Eye Roofing, LLC shall not be liable for delays resulting from a lack of materials, weather phenomena, or any other circumstances uncontrollable by Eagle Eye Roofing, LLC.
Eagle Eye Roofing, LLC shall not be responsible for damages caused by wind caused in excess speeds of 50 MPH wind, driven rain, hail, ice, tornadoes, or any other Acts Of God, during the time of warranty. The warranty is non-transferable unless otherwise noted on the face of this agreement.
Any representation, statements, or other communication not in writing on this agreement shall be considered immaterial, not relied on by Eagle Eye Roofing, LLC or the insured, and do not survive the execution of this contract.
The maximum liability of Eagle Eye Roofing, LLC shall not exceed the original cost of materials and labor from the insurance companies' estimates in the event of any litigation.
During the work in progress, Eagle Eye Roofing, LLC shall not be responsible for any damage to the property's interior or exterior, not due to the negligence of the contractor.

Insurance Loss Report

Address

Insured Info

Adjuster Info

Inspection Info

Siding Inspection

Signature/ Concent