Work Authorization Agreement & Terms of Service

This Work Authorization Agreement (“Agreement”) is made this by and between "VA Water Damage LLC" (“Provider”) (hereinafter referred to as "Restoration Doctor").and  (“Client”) (hereinafter referred to collectively as the "Parties").

WHEREAS, the Client desires to hire Restoration Doctor to perform emergency mitigation and restoration services for the property located at;


WHEREAS, The Client authorizes Restoration Doctor to proceed with its recommended procedures to secure from further damage, preserve, protect, and restore the Property.

WHEREAS, Restoration Doctor, which is in the business of providing, among other services, emergency water, and fire damage cleanup, mitigation, and restoration services, desires to provide such services to the Client upon the terms and conditions provided herein; and

WHEREAS, the Parties desire to enter into this Agreement to set forth the terms and conditions that will govern the Provider’s provision of the Services to the Client.

THEREFORE, for good and valuable consideration, the receipt of which is hereby acknowledged, upon the general terms and subject to the conditions set forth in this Agreement and intending to be legally bound, the Parties hereto agree as follows:

DIRECTION OF PAY: Providing the Client has valid and adequate insurance coverage for all or part of the services to be performed by Restoration Doctor, the Client authorizes and directs their insurance carrier to pay Restoration Doctor directly and to name Restoration Doctor on any insurance drafts applicable to this loss. 

I understand my credit card will be charged after receiving the bill and I will be responsible for collecting the amount from my insurance carrier. 

ASSIGNMENT OF INSURANCE BENEFITS: Client hereby assigns any and all insurance rights, benefits, proceeds, and causes of action under any applicable insurance policies to Provider. This assignment is made in consideration of the Provider performing the services, and not requiring a down payment from the Client prior to starting work. The Client hereby acknowledges that the insurance company is billed as a courtesy and convenience to the Client; should the Client's insurance company fail to honor the assignment of claims and interest, and direction to pay, the Client agrees to pay the Provider any balances due from the Clien'ts personal funds.  The Client further acknowledges and agrees that Restoration Doctor is working for the Client, and not for their insurance company. Therefore, it is understood that the Client is ultimately responsible for full payment of services rendered pursuant to this Agreement.



Check all the boxes, please.

Third Party Authorization: I have hired “Provider” as to make the repairs at my “Property”. As a result of the damages I have filed a claim with my “Insurance Carrier”, and provided the “Claim Number”. I hereby authorize my “Provider” to submit estimates, supplements and bids for the repairs to my property so it may be returned to a pre-loss condition. I also authorize my “Provider” and their administrative partners to communicate with my insurance carrier directly, by phone, e-mail or regular mail, regarding the loss and the repairs needed to return my property to its pre-loss condition. I also authorize my “Insurance Carrier” to share documents and disbursement of funds with my “Provider” and their administrative partners in regard to this "Claim Number”. I hereby request my "Insurance Provider" to not refuse to speak with the individuals that represent the "Provider" – as their contact is authorized by me. I will be incurring charges for general contractor overhead and profit for the repairs to my property. I understand that my policy provides for payment of Overhead and Profit and that O&P is accounted for in the premiums I pay for my policy. I do not have the time or expertise to hire and coordinate the various trades and order the proper materials to make the necessary repairs at my property, which is why I have elected to hire a general contractor to handle this for me.
I also expect for the removal of the damaged materials to be preformed by the appropriate trades for the task as I do not want to expose myself to the risk of having unskilled laborers damaging my property or compromising my warranties and that the skilled laborers be paid according to their trade labor rates.


Effect of Abnormal Water:
Water indoors is an abnormal condition and may cause or contribute to several problems. The potential for property damage and adverse health effects increases the longer materials remain wet. There are at least four progressive stages of indoor water damage.

  1. Water migrates into areas not affected initially. Water spreads laterally into adjoining rooms, penetrates materials below, and wicks up into porous materials above. It is best to evaluate all affected areas, not just areas with visible saturation.
  2. Saturated materials begin swelling as they absorb moisture. Drying and restoration will restore them in many situations, and the damage may be permanent in others. Rapid drying will help reduce the chance of permanent damage.
  3. As water evaporates, it causes an abnormal humidity condition. High humidity can damage some porous materials if allowed to continue. Humidity damage is most common when the indoor humidity exceeds 60% over time. It is best to reduce indoor humidity quickly to help prevent humidity damage.
  4. After water intrusion, mold and bacterial spores can germinate and multiply. Microorganisms can cause mold damage and degrade indoor air quality. Some microorganisms produce antigens and allergens, which cause allergies, while others can cause infections and toxic diseases.


Reducing Mildew Growth & Damage:
Several things can be done to help reduce mold growth and damage to affected materials: 

  1. Water can be removed;
  2. Antimicrobial agents can be applied to help inhibit the growth of mold and other bio-contaminants;
  3. Rapid air movement can be introduced into areas and cavities to increase the rate of evaporation, and
  4. Relative Humidity (RH) indoors can be reduced.

I understand that Restoration Doctor (i) is not a mold remediation company; (ii) Does not guarantee or warranty that it can identify or remove mold; (iii) that a company possessing expertise in mold remediation must be hired to help ensure proper identification, testing, and removal of mold and mildew; and (iv) Restoration Doctor's services may only help, not prevent or resolve, any issues related to mold and mildew.


I, the Owner/Agent for the above Property, authorize Restoration Doctor, its subcontractors, its agents, and representatives to enter my property, furnish materials, supply all equipment, and perform all labor necessary to mitigate, preserve, and protect my property from further damage, and to perform all restoration procedures necessary to repair and restore the carpet, furniture, structure, building materials, and other furnishings.


Pricing and Payment:
I understand that water damage is a progressive condition and that drying time varies depending on the types of materials, the quantity of water, degree of saturation, airflow volume and velocity, temperature, and indoor & outdoor humidity. Therefore, I understand it is impracticable to give an accurate quote for services before completion. I agree to pay the total price for the work Restoration Doctor performs. Restoration Doctor uses an industry-standard price list for mitigation services; a copy is available upon request.


Stop Work-Hold Harmless:
In the event that Restoration Doctor is prevented from performing its recommended mitigation and remediation procedures and/or drying equipment is removed prematurely, I agree to release and hold Restoration Doctor harmless and indemnify Restoration Doctor and all of Restoration Doctor's subsidiaries, subcontractors, and agents against any claims, actions, and liabilities that may result from such incomplete procedures


Authorization to Apply Antimicrobial Agents:
To inhibit the growth of microorganisms during the drying process, industry best practice involves the treatment of wet materials with a commercial antimicrobial agent. The Client hereby authorizes Restoration Doctor to treat all wet materials with antimicrobial agents as part of the mitigation and restoration process.  

I understand that Restoration Doctor's services do not include mold inspections or mold removal. Therefore, I agree to release, indemnify, and hold Restoration Doctor harmless for any biological odors or growth, indoor air quality degradation, and any mold-related personal injuries or other damages to health that may occur due to microbiological activity during and/or after the mitigation process.



Drying Equipment:
I understand that high-velocity air movers (“fans”) and dehumidifiers will be installed to increase the rate of drying. The Client represents and warrants that they:

  • Will not allow children to play with this equipment;
  • Will not turn off the equipment without first calling Restoration Doctor;
  • Will not leave windows open unless expressly instructed to do so by Restoration Doctor, as this may delay or impair the drying process; and
  • Will minimize entering the affected rooms, especially those where the carpet is being dried.


Health and Safety:
To ensure the health and safety of the Client and Restoration Doctor’s agents and representatives on the Property, the Client represents and warrants that they shall abide by the following precautions:

  • If dehumidifiers or fans are moved, these units shall be shut off and unplugged, as it may be hazardous to move these units while they are operating.
  • Take care when walking near the tackless strip, as the exposed tackless strip presents a danger even when covered.
  • Take extreme care when walking on, around, or from wet flooring materials, as floors may become slippery when wet.


Airborne Contaminants:
Restoration Doctor’s mitigation efforts can sometimes cause preexisting contaminants to become airborne, exposing those on the Property to various health risks. As a result, Restoration Doctor highly recommends that all persons coming into contact with the Property during the mitigation and remediation process wear Protective Personal Equipment (PPE). Restoration Doctor also recommends that all occupants of the Property seek alternative work or living arrangements while mitigation and remediation efforts are underway. In the event the Property remains occupied, the Client represents and warrants they shall take reasonable care to protect any occupants from any health hazards presented by the Property during this period, including, but not limited to: Asbestos, Lead, Mold, Etc. The Client further agrees to release, indemnify, and hold Restoration Doctor and its subcontractors, agents, representatives, etc. harmless for any biological odors, growths, or degradation of indoor air quality that may result during and/or after the mitigation and remediation process.


Site Hazards:
Active mitigation and remediation work sites can present many dangerous conditions that may result in injury to the Client and others who enter the Property. The Client agrees to release, indemnify, and hold Restoration Doctor and its subcontractors, agents, representatives, etc. harmless for any personal injuries or damage to the health and well-being of all those who enter the Property both during and after the mitigation and remediation process.


Equipment Responsibility:
The Client represents and warrants that:

  • They are personally liable for any damage to, loss, or theft of Restoration Doctor's equipment while in their care and custody; Also,
  • They shall take reasonable precautions to ensure that Restoration Doctor's equipment is not lost, stolen, or damaged.

If Restoration Doctor's equipment is lost, stolen, or damaged, the Client hereby agrees to pay for the total replacement cost of Restoration Doctor's equipment and all consequential losses resulting from the damage, loss, or theft of Restoration Doctor's equipment.


Insurance Payments:
If an insurance company makes any payment directly to the Owner/Agent, payment shall be remitted to Restoration Doctor within three (3) working days. The Client represents and warrants that they are personally liable for all work performed by Restoration Doctor, Restoration Doctor's subsidiaries, and Restoration Doctor's subcontractors, agents, and representatives, regardless of whether an insurance company covers the loss or not. Any charges for services not reimbursed by an insurance company are due upon completion of the work.


The Client acknowledges and agrees that, due to the emergency nature of the services being provided, Restoration Doctor is incapable of providing a detailed, written estimate of the services to be performed, or with a statement of the materials to be used during, or specifications for, the services or an approximate completion date prior to completion of work. The Client further understands and agrees that Restoration Doctor's services under this Agreement will commence immediately upon signing.


Unrelated Conditions/Work:
The Client acknowledges and agrees that Restoration Doctor is not responsible for detecting, addressing, correcting, or repair of conditions or areas unrelated to the event that necessitated the retainment of Restoration Doctor's services. The Client understands and agrees that the Client is personally responsible for any and all charges, costs, and deductibles not covered by insurance.


Special/Fragile/Valuable Items:
The Client agrees to take full responsibility for special, fragile, or valuable items of personal property, and that Restoration Doctor, Restoration Doctor's employees, and agents shall not be liable for the theft, damage, or disappearance of any such items. The Client represents and warrants that they shall take care to protect and secure any special, fragile, or valuable items of personal property prior to the beginning of the work. Such items include, but are not limited to Jewelry, Cash, Weapons, and Medications.


Environmental Conditions:
The Client understands and agrees that certain amounts of mold and bacteria are normal in an indoor environment, and Restoration Doctor makes no representations, warranties, or guarantees that it can, will, or has left the Property sterile. The Client further understands and agrees that the presence of certain type's microorganisms in indoor environments may cause illness and/or damage to the Property and that the use of certain chemicals may reduce this risk. Infants, the elderly, and individuals with chemical sensitivities or respiratory problems may be particularly sensitive to certain types of microorganisms.


Preexisting Contaminants:
I understand that Restoration Doctor (i) is not an Environmental Testing Contractor; (ii) does not guarantee, represent, or warrant that it can identify or remove pre-existing contaminants; (iii) that a company possessing expertise in toxic materials must be hired to help ensure proper identification, testing, and removal of such contaminants.


Required Information:
The Client shall provide Restoration Doctor with a complete history of known information regarding relevant or potentially relevant facts about the structures erected upon, and the conditions present in and around, the Property. The Client is responsible for advising Restoration Doctor, in writing, of the known existence of hazardous substances, including, but not limited to: Chemicals, Lead, Asbestos, and Areas of possible danger.


Site Access and Security:
The Client agrees to provide access to the Property to Restoration Doctor, Restoration Doctor's employees, agents, subcontractors, and their vehicles and equipment as required to properly perform the services. The Client shall provide areas for storage of equipment, materials, and debris. The Client shall provide all water, electricity, and other utilities necessary for Restoration Doctor to perform its services. The Client represents and warrants that it will take all reasonable measures necessary to secure all structures on the Property from unauthorized access.


Limit of Liability:
Client agrees to release, hold harmless, defend (including, but not limited to, payment of attorneys' fees, expert fees, arbitration costs, and court costs) and indemnify Restoration Doctor from any and all damages, claims, or actions that arise from (i) conditions that pre-existed the specific loss or event Restoration Doctor was hired to address; (ii) the premature removal of equipment or termination of services against Restoration Doctor's recommendations; (iii) any refusal to allow Restoration Doctor to perform any services or procedures Restoration Doctor or its agents recommend; and for any problems that may occur including, but not limited to: mold, bacteria, structural damage, indoor air quality contamination, and environmental illnesses (including allergies, asthma, and alleged toxic effects).


Scope of Work & Supplemental Work:
The Client agrees that all costs related to any required supplements or additions to work or code requirements that are not covered by insurance are the sole responsibility of the Client. Supplemental work includes betterment; owner-selected changes, and/ or enforcement of code or ordinances by the municipality or building department.

Terms and Conditions of Service

R E A D  C A R E F U L L Y

Note: This Agreement includes a limitation of liability and limitation of remedies.


Restoration Doctor’s performance of the Services is limited by, among other things, the preexisting conditions and characteristics of the Property, material, fabrics, furniture, and/or other items. Restoration Doctor expressly disclaims any responsibility or liability for any known or unknown preexisting conditions. Client shall retain responsibility and shall be liable for all effects of and costs necessary to correct such conditions, including, by way of example and not limitation, the conditions identified below:

  1. Restoration Doctor may, in its sole discretion, pre-test materials for removability of spots or stains; dye or color fastness; shrinkage; fading; adhesive breakdown; or other problems. It is not always possible to determine these conditions in advance.
  2. Restoration Doctor does not represent, warrant, or guarantee that wall and ceiling cleaning will restore the original color to painted surfaces.
  3. Not all building materials and furnishings are conducive to cleaning. Restoration Doctor shall use reasonable efforts to advise the Client of any adverse effects which may be reasonably foreseen due to the nature of the fabrics or materials involved. Restoration Doctor does not represent, warrant, or guarantee that such materials can be cleaned or that there will be no adverse effects from any attempt to clean such materials.
  4. A variety of materials are used in the manufacturing and construction of buildings and furnishings. These materials include backings, linings, tacks, and many other unknown substances that may cause discoloration and other adverse effects on the face material or its structural integrity. The Client acknowledges that it is impossible to determine when such adverse effects may occur, and Restoration Doctor does not represent, warrant, or guarantee against such adverse effects.
  5. The Client acknowledges and agrees that mold is commonly found throughout indoor environments and that it is impossible to fully eradicate mold. Restoration Doctor does not represent, warrant, or guarantee the removal or eradication of mold.
  6. The Client acknowledges and agrees that Restoration Doctor does not represent, warrant, or guarantee detection or repair of the original cause of the damage it is hired to mitigate.

Warranties:  Restoration Doctor specifically disclaims any other representations, warranties, and implied warranties (either in fact or by operation of law), including, but not limited to, any implied warranties of merchantability and fitness for a particular purpose of any implied warranty arising out of a course of dealing, custom or usage of trade. This Agreement provides for the provision of services and does not provide for the sale of goods.

Limitation of Liability: In no event shall Restoration Doctor, its owners, any officers, directors, employees, agents, subcontractors, or affiliates be responsible for indirect, special, nominal, incidental, punitive, or consequential losses or damages, or for any penalties, regardless of the legal or equitable theory asserted; including contract, negligence, warranty, strict liability, statute or otherwise, even if it had been aware of the possibility of such damages or they are foreseeable; or for claims by a third party. The maximum aggregate shall not exceed three times the amount paid by the Client for the services or actual proven damages, whichever is less. The Client agrees that the remedies expressed herein represent the sole and exclusive remedies available to the Client under this Agreement. The limitations herein shall apply even if any other remedies fail their essential purpose.

Additional Work: Any labor, materials, or other work beyond those identified in this Agreement shall require a written amendment to this Agreement and will result in additional charges.

Nonperformance and Breach of Contract: Any claim by the Client for faulty performance, nonperformance, or breach under this Agreement for damages, shall be made in writing to Restoration Doctor within sixty (60) days after completion of services. Failure to make such a written claim for any matter which Restoration Doctor could have corrected shall be deemed a waiver of said claim by the Client. No action, regardless of form, relating to the subject matter of this Agreement may be brought more than one (1) year after the claiming party knew or should have known of the cause of action.


Headings: The headings contained in this Agreement are for convenience of reference only, form no part of this Agreement, and have no force or effect whatsoever.

Force Majeure: With respect to the performance obligations of this Agreement, where there occurs any prevention, delay, or stoppage due to strikes, lockouts, labor disputes, acts of God, inability to obtain services, labor, or materials, or reasonable substitutes therefor, governmental actions, civil commotions, fire, flood, civil commotion, riot, war (declared and undeclared), revolution, or embargoes and other causes beyond the reasonable control of Restoration Doctor (a Force Majeure event), Restoration Doctor’s failure to perform shall be excused for the duration of such event and for such a time thereafter as is reasonable to enable the parties to resume performance under this Agreement.

No Waiver: A failure of either party to exercise any right provided for herein shall not be deemed to be a waiver of any right hereunder.

Severability Clause: If any provision of this Agreement is found to be ineffective, unenforceable, or illegal for any reason under present or future laws, such provision shall be fully severable, and this Agreement shall be construed and enforced as if such provision never comprised a part of this Agreement. The remaining provisions of this Agreement shall remain in full force and effect and shall not be affected by the ineffective, unenforceable, or illegal provision or by its severance from this Agreement.

Modification and Waivers: No modification, termination, or attempted waiver of this Agreement shall be valid unless in writing and signed by the party against whom the same is sought to be enforced.

Overhead and Profit: Restoration Doctor shall be entitled to an additive of Ten Percent (10%) overhead, and Fifteen Percent (15%) profit for all services rendered by subcontractors; as well as on all appropriate and approved equipment rental, operating and transporting costs. Overhead and Profit percentages shall be considered to include, among other costs; change order processing costs including without limitation project management, estimating, clerical, and drafting costs performed by field operations or in the home office, relating to change in the Work; field supervision; incidental job burdens; cost of idle equipment; home office overhead and consequential damages; general home office expenses; profit; and loss of profit.

Merger Clause: This work authorization contains the final, complete, and exclusive statement of the Agreement between Restoration Doctor and Client with respect to the transactions contemplated herein. All other prior or contemporaneous oral communications (including, for the avoidance of doubt, any communications in connection with the preparation of this work authorization) and all prior written or oral communications and agreements with respect to the subject matter hereof are merged herein and superseded into this work authorization. For the avoidance of doubt, it is the parties’ intent that no term contained in or omitted from any prior written draft of this work authorization or other communication be used as extrinsic evidence under any state law or judicial interpretation to determine the parties’ intent hereto.

No Representations: The Client represents that he/she has had the opportunity to consult with an attorney and has carefully read and understands the scope and effect of the provisions of this Agreement. In agreeing to this agreement, the Client has not relied upon any representations or statements made by Restoration Doctor or its employees, which are not explicitly outlined in this Agreement.

Assignment of Rights: This Agreement and the rights and obligations of the parties herein shall inure to the benefit of, and be binding upon, their respective successors, assigns, and legal representatives.

Preexisting Contaminations: Notwithstanding any other provision of this Agreement, Restoration Doctor shall not be responsible for any Toxic Materials that were on the Property previously. The Client agrees that (i) Restoration Doctor shall not be responsible for any such Toxic Materials regardless of, boundaries or level of contamination, or the cost of clean-up, is increased as a result of mitigation and Clean-up activities that Restoration Doctor may take; and (ii) the Client shall be responsible for any Toxic Material that is discovered, released or disturbed as the result of any excavation or other subsurface activity made or undertaken on the Property by Restoration Doctor or any of Restoration Doctor's Representatives.

Insurance Assignment of Benefits: I hereby authorize my insurance company to pay Restoration Doctor directly for their services. As the Owner or Authorized agent of the property owner, it is understood that I have authorized the work and accept responsibility to Restoration Doctor for services rendered. It is fully understood and agreed that the Owner/Agent is personally responsible for the total costs and charges for the work, including but not limited to any deductible, depreciation, or holdback not covered by insurance. If the Client’s insurance carrier pays Restoration Doctor directly, any charges for services not reimbursed by the insurance carrier are the Client’s sole responsibility and must be paid upon completion of work. Restoration Doctor must approve any exceptions in writing, and a finance charge of 1.5% per month (minimum of $1.00), will be applied to any unpaid balance after thirty (30) days.


Invoicing: Restoration Doctor shall bill all charges and costs directly to the Client (insured), and, as a courtesy only, a copy of these documents will be e-mailed to the insurance carrier. It is fully understood and agreed that Restoration Doctor is hired directly by the Client and is in no way required to communicate, deal, negotiate with, or provide any internal notes, documents, or images to the Client’s Insurance company, or any other Third Party on the Client’s behalf and that all charges and costs are due upon completion of work.

Third Parties: The Client understands and agrees that Restoration Doctor is (i) not a public adjusting firm, (ii) does not provide adjusting services, and (iii) will not negotiate with their insurance company on their behalf. If such services are required due to the complex nature of a claim, the Client should retain the services of a licensed and qualified public adjusting firm to negotiate with their insurance carrier on their behalf. At no time will Restoration Doctor accept a ‘Third Party Assessment’ of the loss post-mitigation. That includes but is not limited to any insurance company’ Third Party Vendor’, or ‘Third Party Estimate’ for work performed by Restoration Doctor or Restoration Doctor’s employees, subcontractors, and agents.

Proof of Loss: If proof of loss is required by an insurance carrier or any other third party, the Client is required to keep and maintain their own records. As standard operating procedure and to chart progress, Restoration Doctor’s employees and agents take daily photos, notes, background measurements, and environmental readings, and keep track of services and tasks performed. These documents are used to chart drying progress and to help determine if additional equipment or services are required and when Dry-Standard has been reached. Restoration Doctor is in no way required or agrees to share, any of its internal documents with the Client, or any other third party. As a courtesy only, and at its own sole discretion, in order to help clients, navigate the claims process or seek reimbursements; Restoration Doctor may choose to provide some relevant documents pertaining to the project. Doing so does not invalidate the terms of this Agreement and shall not be considered a course of conduct. Restoration Doctor may share some or none of its internal documents at its own sole discretion.

Debt Collection & Credit Report:  Within 45 days of delinquency, the provider will report the client including all individuals on the contract, to one or both main national credit agency. Normally this will occur for all loans more than 40 days delinquent at a month end. The provider will continue to report account delinquency on a monthly basis up to claim payment date. Tolerance for delayed reporting is plus or minus 30 days. 

Attorneys’ Fees: Should the need arise for legal action to collect monies due under this Agreement, or should the matter be turned over to collections, Restoration Doctor shall be entitled, in addition to other amounts owed by the Client, to reasonable legal fees and costs of any such collection attempts, and a finance charge of 1.5% per month (minimum of $1.00). This attorney fee provision shall not be effective or enforceable in jurisdictions where attorney fee provisions are made reciprocal or invalid by operation of law. Consent is hereby given for filing of a mechanic’s lien by Restoration Doctor for the work described in this Agreement on the Property.

Governing Law: This Agreement and the rights and obligations of the parties under it are governed by and interpreted in accordance with the laws of the Commonwealth of Virginia (without regard to principles of conflicts of law.) The Client consents to the jurisdiction of the Commonwealth of Virginia and the Venue of Fairfax County, Virginia for any litigation regarding this Agreement.

Waiver of Right to Jury Trial: Both Restoration Doctor and Client waive their respective rights to a trial by jury with respect to any and all claims or causes of action (including counterclaims) related to or arising out of or in any way connected to this Agreement and agree that any claim or cause of action will be tried by a court trial without a jury.



I have read and understand the information above and have received a copy for my records.




Full Name: *Required

Phone Number: *Required

Email: *Required

Insurance Company:

Claim Number:


Leave this empty:

Signature arrow sign here

Signed by Shayan Jafari
Signed On: March 23, 2024

Signature Certificate
Document name: Work Authorization Agreement & Terms of Service
lock iconUnique Document ID: c6b7dc3ed6d8cb7ed2337ed4a8561970f435fe25
Timestamp Audit
March 15, 2023 9:35 pm EDTWork Authorization Agreement & Terms of Service Uploaded by Restoration Doctor - [email protected] IP