1.2. OS NEW PROJECT FORM / WORK AUTHORIZATION

NEW PROJECT FORM:

Duration 10 - 20 minutes
Obsidian is ready to take care of you from end-to-end, as we are the best and fastest in the biz!

We stay in business by leaving clients happy, not by twisting arms, and we pride ourselves on being easy to work with.

Filling this out to the best of your ability allows us to do our job to the best of ours, so we can take as much off your plate as possible.

This Form/Work Authorization is required for us to proceed, even if you only want us to perform an inspection. It is cancelable at any time.

If you would like a refresher, this short video below covers our process and the most common FAQs.
(first 5 min Intro, next 5 min FAQs. Can speed up watching speed)

Much of the form will remain blank because we have fields for any scenario, most of which may not pertain to your Project, so do not fear its seemingly daunting size
Rough Project Description. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
Is Project style
Is this Project Insurance related, OOP (Out-of-Pocket (includes financed projects)), or not yet sure?
Is Project (select all that apply)

Other
If Other, please describe
Is Project
Desired Start Date

MonthDayYear
Date
Client Budget Amount
S
Does Client need financing? If yes, Obsidian Solutions can help! See at www.Legacy-RED.com
Client 1 First Last (Make sure this is the primary policyholder / person of contact)

First NameLast Name
Client 1 Phone Number
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Client 1 Email
example@example.com
Client 2 First Last (if applicable)

First NameLast Name
Client 2 Phone Number (if applicable)
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Client 2 Email (if applicable)
example@example.com
Client Company Name (if applicable)
Worksite Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Mailing Address (if different than worksite)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Worksite Codes Required for Access like gates, doors, contractor boxes, hidden key locations, garage doors
Living situation for the duration of the project (if relevant)
Any other estimates, if yes, their price? Feel free to upload any files into the Upload Section (bottom of form)
$
Tenants Name (if applicable)

First NameLast Name
Tenants Phone Number (if applicable)
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Insurance Info (if applicable):
Insurance Company (IMPORTANT)
Clients Claim Number (IMPORTANT)
Insurance Adjuster Name (IMPORTANT)

First NameLast Name
Insurance Adjuster Phone Number (IMPORTANT)
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Insurance Adjuster Phone Extension (if Generic phone number)
Example: Xt 101
Insurance Adjuster Email (IMPORTANT)
example@example.com
Insurance Adjuster Supervisor Name (if available)

First NameLast Name
Insurance Adjuster Supervisor Phone Number (if available)
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Insurance Adjuster Supervisor Phone Extension (if applicable)
Example: Xt 101
Insurance Adjuster Supervisor Email (if applicable)
example@example.com
Date Damage Occurred

MonthDayYear
Date
If Insurance Project, does Client already have a company doing mitigation work? Definition of Mitigation Work: in property claims/restoration it is the immediate, temporary actions taken right after a loss to stop or reduce further damage and make the site safe/stable—before permanent repairs. Typical tasks: water extraction and structural drying, board-up/tarping, temporary shoring, debris/water removal, isolating affected areas (smoke/soot/mold containment), and securing utilities—generally billed as necessary “emergency services” under the policyholder’s duty to mitigate clause
Has Client received funds from insurance?
Any known Budget from Insurance? If yes, how much?
$
Any known policy maximum amount, if yes, how much?
$
If you have your Policy, please upload. Usually a 40+ page document

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Any Additional Info Pertaining to Insurance. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
Insurance Info 2 (if applicable):

This is in the circumstance where 2 insurance companies are involved simultaneously!!!! Examples: 1) you filed a claim and your tenant filed a claim. 2) you filed a claim and the emergency services broke a pipe that caused more damages
Insurance Company 2 (IMPORTANT)
Clients Claim Number 2 (IMPORTANT)
Insurance Adjuster Name 2 (IMPORTANT)

First NameLast Name
Insurance Adjuster Phone 2 Number (IMPORTANT)
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Insurance Adjuster Phone Extension (if Generic phone number) 2
Example: Xt 101
Insurance Adjuster Email 2 (IMPORTANT)
example@example.com
If Insurance Project, does Client already have a company doing mitigation work? Definition of Mitigation Work: in property claims/restoration it is the immediate, temporary actions taken right after a loss to stop or reduce further damage and make the site safe/stable—before permanent repairs. Typical tasks: water extraction and structural drying, board-up/tarping, temporary shoring, debris/water removal, isolating affected areas (smoke/soot/mold containment), and securing utilities—generally billed as necessary “emergency services” under the policyholder’s duty to mitigate clause. 2
Date Damage Occurred 2

MonthDayYear
Date
Has Client received funds from insurance? 2
Any known Budget from Insurance? If yes, how much? 2
$
Any known policy maximum amount, if yes, how much? 2
$
Any Additional Info Pertaining to Insurance. Feel free to add any relevant attachments in the Upload section at the bottom of the Form. 2
FEMA Info (if applicable):
FEMA Case Number
Any Additional Info Pertaining to FEMA. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
HOA Info (if applicable):
Is Worksite in an HOA?
HOA Primary Contact Name

First NameLast Name
HOA Phone Number
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
HOA Email
example@example.com
Any Additional Info Pertaining to HOA. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
Mitigation Info (if applicable):
Mitigation Company Name
Mitigation Project Manager Name

First NameLast Name
Mitigation Project Manager Phone Number
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Mitigation Project Manager Email
example@example.com
Estimated Mitigation Completion Date

MonthDayYear
Date
Any Additional Info Pertaining to Mitigation. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
Lender/Mortgage Info (if applicable)
Lender Company Name
Lending Agent Name

First NameLast Name
Lending Agent Phone Number
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Lending Agent Email
example@example.com
Any Additional Info Pertaining to Lender. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
Real Estate Agent Info (if applicable):
Does Client already have a Real Estate Agent representing them? If no, our sister Company Legacy RED can help! Go to "Our Team" on our website www.Legacy-RED.com
Real Estate Agent Name

First NameLast Name
Real Estate Phone Number
Please enter a valid phone number. By submitting a phone number you are agreeing to opt-in for SMS messaging. Reply STOP to opt-out. Format: (000) 000-0000.
Real Estate Agent Email
example@example.com
Any Additional Info Pertaining to Real Estate Agent. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
Final Info (if applicable):
Any Essential Links pertaining to the Project
Any Essential Links pertaining to the Project
Any Essential Links pertaining to the Project
Any Additional Information Pertaining to Project. Feel free to add any relevant attachments in the Upload section at the bottom of the Form.
How did you hear about us
Bank Name
ie: US Bank
Bank Account Number (Essential for Property Damage Projects so we can save your timeline 3 weeks to 3 + months. If you are not a Property Damage Project, you can just fill in the field with an X)
8 to 12 digits
Bank Routing Number (Essential for Property Damage Projects so we can save your timeline 3 weeks to 3 + months. If you are not a Property Damage Project, you can just fill in the field with an X)
9 digits
Upload any relevant pictures, videos, and documents

Examples: voiceover video of walking through the worksite showing source and result of damages, drawings and measurements of the site, inspiration images, material lists, insurance estimates, other estimates, engineering reports, Matterport (3D/2D rendering software), ITEL, Encircle, Xactimate, photos, etcetera, anything that may be relevant and is attach-able. 3 GB Maximum. Any additional info that cannot be uploaded below, email to PM@ObsidianSolutions.global
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CLICK ME TO VIEW WORK AUTHORIZATION (LINK)
By checking "YES” below and signing this Form, I acknowledge and agree that: 1. I have been provided access to, and have had the opportunity to review, the Work Authorization applicable to the property state listed as the Worksite Address on this Form. 2. I expressly confirm that I have read, understood, and accept the terms of the Work Authorization for that state, which is incorporated herein by reference. 3. By my signature below, I agree that this Form and the applicable Work Authorization together constitute a single, binding contract between myself (the Client) and Obsidian Solutions, covering the property located at the Worksite Address identified above. 4. I understand that my signature below applies specifically and exclusively to the Work Authorization governing the state where the Worksite Address is located. 5. I further acknowledge that all information provided by me in this Form is true, complete, and forms part of the contract.
Signature
Thank you for filling this out to the best of your ability. We at Obsidian Solutions are looking forward to serving you! As a part of our Privacy Policy, we will not share any of the information received by our customers. Submission of this form is an opt-in to receive sms text messages from our company. See our Privacy Policy at https:// form.jotform.com/240505046041038
Should be Empty:

NEW PROJECT FORM:

Insurance Info (if applicable):

Insurance Info 2 (if applicable):

FEMA Info (if applicable):

HOA Info (if applicable):

Mitigation Info (if applicable):

Lender/Mortgage Info (if applicable)

Real Estate Agent Info (if applicable):

Final Info (if applicable):