Work Authorization Form

Battle Born Restoration Specialists, LLC (hereafter known as BBRS)

Date of Loss

Date

Type of Loss

Other

WORK AUTHORIZATION: I, First Name Last Name , the Owner/Agent for the property listed below, authorize BBRS to enter my property, furnish materials, supply all equipment, and perform all labor necessary to repair and protect my property from further damage.

I Agree

DIRECTION OF PAYMENT: I, First Name Last Name hereby authorize BBRS, be given irrevocable and express permission to endorse my name on any and all checks received from an insurance carrier on my behalf for services provided by BBRS. I believe my insurance carrier to be Carrier Name . I agree that any portion of work, deductibles, betterment, depreciation or additional work requested by the undersigned, not covered by insurance, must be paid by the undersigned on or before its completion. I also hereby authorize and unequivocally instruct direct payment of any sums of money and or proceeds to BBRS for the contracted services. I instruct my insurance carrier to make any insurance proceeds payable directly to BBRS for the contracted services. In the event BBRS is not allowed to perform its repairs and/or equipment or materials are removed prematurely, I agree to release and hold BBRS harmless, and indemnify BBRS against all claims or actions that may result from such procedures.

I Agree

Please Read and Initial each item below by checking the box.

Porous Contents

In the event that all porous contents and furniture throughout property are not removed and discarded, the property owner agrees to release and hold BBRS harmless and indemnify BBRS against all claims or actions that may result from the declining and/or failure to have the porous contents removed from the property and discarded. BBRS will hepa vacuum and treat all porous contents but cannot guarantee the removal of all mold or micro toxins.

Stop Work-Hold Harmless

Clearance Testing

Authorized Antimicrobial Agents

I understand that in the best judgement of BBRS, materials may be treated with a Commercial antimicrobial agent to inhibit the growth of micro-organisms during the remediation process. I have received advanced notice of the use of antimicrobial and/or antimicrobial product as part of the remediation process. I understand it is beyond the expertise of BBRS to determine is someone is sensitive to its application and will hold BBRS harmless for its use.

I have read and understand the information above and have received a copy for my records.
If any part of this agreement is declared unenforceable or invalid, the remainder will continue to be valid and enforceable.

Today's Date

Policy #

Owner/Agent

First NameLast Name

Claim #

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState

Zip Code

Signature