Assignment of Benefits, Contract For Services



CONTRACT FOR SERVICES, ASSIGNMENT OF BENEFITS

I, the Owner/Agent for the job site listed below, authorize The Restoration Doctors LLC. (hereinafter referred to as “Company”) to enter my property, furnish materials, supply all equipment and perform all labor necessary to preserve and protect my property from further damage.

ASSIGNMENT OF INSURANCE BENEFITS
I hereby assign any and all insurance rights, benefits, proceeds, and any causes of action under any applicable insurance policies to The Restoration Doctors LLC, for services, rendered or to be rendered by The Restoration Doctors LLC. By executing this document, I intend for all rights, benefits, and proceeds for services rendered by The Restoration Doctors LLC to be assigned solely and exclusively to The Restoration Doctors LLC. In this regard, I waive my privacy rights. I make this assignment in consideration for The Restoration Doctors LLC agreement to perform labor, services, supply materials, and perform its obligations under this contract, including not requiring full payment at the time of service. I hereby unequivocally direct my insurance carrier(s) to release any and all information requested by The Restoration Doctors LLC, its representative, and/or its attorney for the purpose of obtaining actual benefits to be paid by my insurance carrier(s) for services rendered or to be rendered.

DIRECT PAYMENT AUTHORIZATION
I hereby authorize and unequivocally instruct direct payment of any benefits or proceeds for services rendered by The Restoration Doctors LLC to be made payable solely to The Restoration Doctors LLC and sent exclusively to The Restoration Doctors LLC I agree that any portion of work, deductible(s), betterment, depreciation, or additional work requested by me, or otherwise not covered by insurance, is ultimately my responsibility.

PAYMENT TERMS
Payment terms to Company are net-30 days. Late charges of 1.5% monthly are charged to any and all unpaid balances. Company shall be entitled to reimbursement for costs of collection (including reasonable attorney’s fees and costs) of unpaid amounts by Owner/Agent and for reasonable attorney’s fees and costs for the breach, or enforcement, of any terms of this entire service agreement.

AUTHORIZED ANTIMICROBIAL AGENTS
I understand that in the best judgment of Company, materials may be treated with a Commercial antimicrobial agent to inhibit the growth of micro-organisms during the drying process. I have received advanced notice of the use of antimicrobial and/or antimicrobial products as part of the restoration process. I understand it is beyond the expertise of Company to determine if someone is sensitive to its application and will hold Company harmless for its use.

STOP WORK-HOLD HARMLESS
In the event Company is not allowed to perform its recommended procedures and/or drying equipment is removed prematurely, I agree to release and hold Company harmless, and indemnify Company against all claims or actions that may result from such procedures.

The Restoration Doctors LLC will Perform any or all of the Following Services:  

  • Emergency Services
  • Mold Remediation
  • Construction Services

CUSTOMER OR AUTHORIZED AGENT

Full Name:


Telephone:


Email:


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Signed by Steve Darakhshan
Signed On: March 1, 2022


Signature Certificate
Document name: Assignment of Benefits, Contract For Services
lock iconUnique Document ID: 1a269488ac9638f46e783ae6d937f901c617f6f1
Timestamp Audit
February 22, 2022 1:34 pm EDTAssignment of Benefits, Contract For Services Uploaded by Shoughi Darakhshan - [email protected] IP 50.78.6.46