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"110 Gale Force Roofing and Restoration. <br /> 3902 Henderson Blvd, Ste 208#337 <br /> GALEFORCE TAmpa,,FL 33629 <br /> ROOFING & RESTORATION <br /> (0) 813.805.8096 <br /> Lic: CCC 1331253 <br /> ASSIGNMENT OF INSURANCE CLAIM <br /> Client to Contractor <br /> The undersigned Insured and Gale Force Roofing and Restoration, LLC. in consideration for the services to <br /> be performed as defined in the contract signed on 2 / / /9 ,hereby transfers and assigns to Gale <br /> Force Roofing and Restoration, LLC., any and all insured's rights,benefits and proceeds due to Insured <br /> under applicable insurance policies pertaining to the insurance claim(s) identified as Claim(s) <br /> No.: an / $ covering loss sustained at the Insured's property at <br /> 3?�/ a•- G� �I�; 'FL 3�y2 (address), <br /> on (date of loss). This transfer and assignment of rights also includes any right of the Insured <br /> to co lect extra contractual damages,consequential damages, common law damages and statutory damages. <br /> This transfer and assignment allows the Contractor to file suit in the Contractor's name to collect the <br /> proceeds assigned herein. <br /> Client agrees that if the Insured's insurance company tries to pay the proceeds to the Insured and/or Insured's <br /> mortgage lender,the Insured will assist Gale Force Roofing and Restoration,LLC.to the insurance proceeds <br /> made payable to Gale Force Roofing and Restoration, LLC. <br /> IN WITNESS WHERE OF,the undersigned have caused this transfer.and assignment of insurance claim to <br /> be duly executed this day of 20_1,q . <br /> Assignor(s): Insured's Name(s) Assignee: Gale Force Roofing and Restoration,LLC. <br /> Printed name of Assignor(Or,Authorized Rep.) Printe name of Assignee Authorized Rep. <br /> -!�Z/Z <br /> Signature and Date Signature and Date <br /> Printed name of Assignor(Or,Authorized Rep.) <br /> Signature and Date <br /> Page 3 of 6 <br />