Roofing/Restorations Contingency Agreement – North American Claims and Restorations

Roofing / Restorations Contingency Agreement & Work Authorization
Name*

First NameLast Name
Property Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
ClaimType*
Insurance Company*
Claim #
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Service Protection

• $2,500 service fee applies if canceled after services are performed
Contractor Role

• Contractor is not acting as a public adjuster

• Only construction-related communication with insurance carrier
Scope of Work

• Full roof inspection and damage documentation

• Insurance scope assistance and adjuster meeting

• Roof repair or full replacement

• Supplement handling for additional damage
Owner Signature*

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Owner Signature Date*

MonthDayYear
Date
Co-Owner Signature

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Contingency Agreement

• Agreement contingent upon insurance approval

• Owner agrees to hire contractor for approved scope

• Insurance proceeds (excluding deductible) used for project

Payment Terms

• Owner responsible for deductible and upgrades

• Contractor follows insurance-approved scope and supplements

Supplement Authorization

• Contractor may pursue additional funds for hidden or missed damage
Co-Owner Signature Date

MonthDayYear
Date
Contractor Representative Signature

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Contractor Representative Date

MonthDayYear
Date
Notice of Right to Cancel
Cancellation Rights Notice
Notice of Right to Cancel - Owner Signature

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Notice of Right to Cancel - Co-Owner Signature

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Should be Empty:

Roofing / Restorations Contingency Agreement & Work Authorization

Notice of Right to Cancel