1.4. OS COC / Review:

Certificate of Completion Portion:
Client's Name*

First NameLast Name
2nd Client's Name (if applicable)

First NameLast Name
Client Worksite Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Claim Number*
Current Adjuster's Email Address (this will automatically email them the COC, saving time!!!)
example@example.com
The Client acknowledges by signing below, that the project for which Obsidian Solutions has provided has been completed to the customer’s (or if applicable, lien holder’s) satisfaction and that the name, address, and claim number filled in above are correct and correlate to the Signature and Date below.
Signature
Date*

MonthDayYear
Date
Review Portion:
Very SatisfiedSatisfiedNeutralDissatisfiedVery Disatisfied
ExcellentGoodFairPoor
Very SatisfiedSatisfiedNeutralDissatisfiedVery Disatisfied
Yes, all issues were handled effectivelyMost issues were handled effectivelySome issues were not handled effectivelyNo, issues were not handled effectively
5. What could we improve to better meet your needs in future projects?*
Thank you so much for the opportunity to serve you!!! It has been our absolute pleasure.

~ Obsidian Solutions
Should be Empty:

Certificate of Completion Portion: