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<br /> CUSTOMER AGREEMENT/ CONTRACT PROPOSAL
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<br /> SCM Roofing of Florida Inc.
<br /> 16603 Plum Rose Court ,
<br /> Tampa,FL 33618
<br /> Phone 855-SCM-ROOF,Ext. 1 Fax 855-SCM-ROOF ,
<br /> info@scmconstructionfl.com
<br /> ' � FL License#CCC1330612-CGC1521516 Sales Rep
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<br /> Customer Name/ � `� ` Insurance Compan�y� Date Reported Date of Loss
<br /> "f ! � -��( V C1`' f; I � ^��:r.�?c_C �-,�I
<br /> Address /� ( /� Claim# �'2,� /� �� C ,[� � Insur�an-��ce Company Number
<br /> i�0/��(C 1 G I�if�C�/� �(�--�-'C./��.) �/ �--L� t�`.�iv..�-' ( f n .��� �
<br /> Ci State Zi � i Polic # � '"' ' Ad'uster Phone#
<br /> ty .�� , ��� � /l5 �� y � �r-�o� ) b1�5 ,,
<br /> Home P�ion�e % -- Mortgage Compariy ) Mortgage Company#
<br /> 't. i �....oc.c.y't � z�"''G'�(
<br /> Cell Phone rJ :�:Loan# i ° T e of Loss
<br /> ��� • ��� — (J�v � �.,. } � .,� , . �f'Wind❑Hail
<br /> 1c .i i i liy,sa,u . •�6;�:'•:... I ,
<br /> $. i's.'s�.
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<br /> '` � Roof Specifications i Property Conditions .;, , �
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<br /> �3-Tab ❑Architectural '' ❑Other ; _ Driveway ,�Cracks /i�Oi1.Sfains
<br /> . � ; • �, �. _
<br /> ❑Tile ❑Metal Roofing ❑Low Slope � Ceilings • ❑Stains . ❑Ivlold ,
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<br /> ❑ 15"Felt .�30"Felt ❑Synthetic,ti a Dumpster f f� Driveway ❑Other
<br /> �' ��'S �- � �',���`
<br /> �Shingle Color Gf i�Pr,'� _ � , Shingle �0 r �`t"� 0 I�Y i;'t_,�a �.Y:�o�
<br /> , �- v , y �, i -
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<br /> (Brand) (Col'or):'`: ; ,,:.
<br /> 0`Drip Edge.Color I,� � !�i;r _ ' �� -
<br /> ,,,�. J �
<br /> � []Y Ridge Vent Brand ��•��' -..A" 1�- 1 G i r: � `� Drip . r� l,t..�U�'`l�A _
<br /> � . � (Color) �'
<br /> ^,%a�?Skylights Brand �.�� � ;� _ -_�_ .. ;
<br /> - , ----- -- =`` ` , -` - ,-. - Notes?,._ _ - � -
<br /> ` Pipe Boots 1 �%z- -- � 2" _� 3' � �:'• ��-�' `� S�--�'.� �� % ,.!�'' ` -
<br /> '�� . _ _. . . _ , , , _ . " �. , , ,
<br /> ' .• Chimney ❑Hardie Hop ❑Stucco ❑T-111 ' ' ' " -
<br /> �.,r _
<br /> �� 0 Viny1,+0 Br•,ick ❑Hardie�Board
<br /> , � - _ '_---_:=`.—;�.` -�'....'-'J---r�;:—i-:�..c��—_-f:�'r.=�-,.,^`, - — .. � . ; ._ �_ _'_.�-�_ �_ _= -_ � -- -_ —" ,__ '
<br /> ``�```` - -.=`��`-=����' �'��'±l4'. --- - -- Total Investment Summary `����� �� �� �
<br /> '-' . DeductibTe � t G�''i'l')•G � It is agreed up;on the amount of the contractor�shall be based on the amount equal to full
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<br /> -• ' replacement cost,value as stated on insurance .scope of loss including deductible and all
<br /> Insurance Proceeds upgrades,supplements,extra charges unless otherwise noted.
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<br /> Change Orders �� /'� _,..J/ -'�' '
<br /> X -%f �_��f� l./�, ' G71 (�i(-..��,-��:_.��
<br /> Owner � '
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<br /> ' Bid Price
<br /> � Due to the unique nature of repairs related to insurance claims,this contract does not include an explicit price because the final scope has not been agreed upon with the insurer.
<br /> � Reaching agreement on the full scope of repairs involves considerable time on Company's part;we will not proceed with this phase unless you agree to allow us to do the work once
<br /> � the scope is agreed upon.By signing this agreement,you authorize SCM Roofing of Florida,Inc.to reach agreement on the price and scope of repairs on your behalf:SCM Rbofing .
<br /> of Florida,Inc.agrees to bid the work using the primary insurance industry pricing database(Xactimate)based on the scope of work agreed upon with your insurer,including ,
<br /> general contractor markup at customary insurance industry rates(20%mazkup;on Xactimate line items).Any substantial additions or deductions to the scope'of work wi116e
<br /> handled by written construction change orders.No verbal contracts agreed to.All items agreed upon must be in writing.IF YOUR INSURANCE COMPANY DENIES YOUR
<br /> CLAIM,THIS AGREEMENT/CONTRACT SHALL BE COME NULL AND VOID.
<br /> NOTICE TO INSURANCE COMPANY•ASSIGNMENT OF CLAIM•COVENANT OF PAYMENT: '.
<br /> Owner hereby assigns any and all insurance rights,benefits,proceeds and any causes of action under any applicable insurance policies which cover the damage to the property
<br /> that Company is to repair pursuant to this contract.Owner further assigns and authorizes Company to seek reimbursement from Owner's insurance carrier for payment owed
<br /> to Company for services rendered or to be rendered by Company via the initiation of a civil action in a court of competent jurisdiction or other means of recovery.In this .
<br /> regard,Owner waives privacy rights.Owner makes,this assignment in`.consideration of Company's agreement to perform services and supply materials and otherwise perform �
<br /> it's obligations under this contract,including not requiring full payment at the time of service.Owner also hereby directs owner's insurance carrier(s)to release any and all
<br /> information requested by Company,it's representative,and/or it's Attorney fori the direct purpose of obtaining actual benefits to be paid by Owner's insurance carrier(s)for "
<br /> services rendered or to be rendered. ' �
<br /> Acceptance of Terms The above specifications,scope of work and conditions'are satisfactory and are hereby accepted.It is agreed upon that the amount of contract shall be
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<br /> "• 6ased on the amount equal to full replacecnent co"st"vatue(RCV)as stated on ttie insurance"scope of loss"including deductilile and all upgrades,supplements,extras/changes,
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<br /> �;`,xw unlessiotheiivise noted.SCM Roofing o£Florida,Inc::is'liereby authorized to do the work as specified above,along with Xactimate estirnate,scope of work,and missing items from
<br /> � ''i`�rist�r�nce loss'report.Owner acknowledges reading,uriderstanding and accepts the additional terms and conditions on'the back of this form.Buye�'s Right to Cancel-If the buyer
<br /> wishes to no longer receive the goods or services presented,buyer may cancel this agreement by providing written notice to SCM Roofing of Florida,Inc.in�Person,by Telegraph
<br /> or by Mail.This notice must indicate that the buyer does not want the goods or services and must be delivered or post marked before midnight of the thiid(3'').business day after
<br /> the agreement is signed. � ` .-: ` .
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<br /> �:>, . � ',� .:-;-� i7 1 i :J��'L'ti=i.L.:�
<br /> � O%v`ner'Approval
<br /> � ��.�� ���� = �
<br /> � �AdditionavOwner Approval �
<br /> By signing this contract, you agree�to al! ter'ms on front and 6ack of this contract �
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