Complex Claims

Work Authorization Residential
Form

4711 Yonge St. FL 10 Toronto, ON M2N 6K8
24/7 EMERGENCY SERVICE: 1.833.378.0701

Client Information:

Owner Name:
Address:
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1. I/We (the ”OWNER”) or our appointed representative(s) authorize Complex Claims Restoration ("Complex Claims") or their representative(s) to perform all necessary actions or services as outlined in the “Scope of Work” (the “WORK”) above, whether or not that WORK is covered by the OWNER’s insurance policy provided by the insurance company (the “INSURER”) indentified above. The OWNER understands that Complex Claims is neither an employee nor a representative of the INSURER and this contract is between the OWNER and Complex Claims.

2. Any amendments to the Scope of Work which result in extra costs or significant delays not covered by the INSURER should be agreed upon by the OWNER and Complex Claims in writing (each, a “Change Order”), and will become part of this contract. If Complex Claims incurs additional reasonable costs necessary to perform the Work which were not anticipated in the Scope of Work, the OWNER will remain liable for the payment of such additional costs even if the OWNER and Complex Claims have not executed a Change Order. Upon execution of any Change Order which increases the estimated cost of the Work, the OWNER shall pay 50% of the amount by which the Change Order increases the original cost. The remaining 50% will be due upon completion of the Work.

3. The OWNER acknowledges that if Complex Claims is performing emergency services, it may not be possible or reasonable to provide an estimate and /or details of the Work before commencing the Work. In cases such as this, Complex Claims will use an industry -approved pricing guide to provide a final invoice. Should any of the required emergency services not be covered by the INSURER, the OWNER will remain responsible for the payment for those services. The charges for all other repairs will be in accordance with the estimates in a Scope of Work that will be provided to the INSURER and OWNER at a later date.

4. The OWNER acknowledges that the payment of any deductible from the OWNER’s insurance policy is the sole responsibility of the OWNER.

5. The OWNER agrees that any Work that is not covered by the INSURER, such as: depreciation, taxes, and any additional Work agreed to by the OWNER are the responsibility of the OWNER. Overdue accounts will accrue interest at 5% per annum.

6. Complex Claims and OWNER will attempt to expediently resolve any disputes and submit unresolved disputes to mediation and thereafter to binding arbitration. Irrespective of any disputes which arise, the OWNER agrees to promptly make all payments to Complex Claims.

7. Unless otherwise notified by the OWNER, the OWNER authorizes Complex Claims to dispose of any non -restorable contents that may be in C o m p l e x C l a i m s ’s possession 30 days after the OWNER receives the final “Non-Restorable Listing” (and, if applicable, any associated photo documentation) from Complex Claims.

8. The OWNER hereby authorizes and directs the Insurance Company to make payment directly to Complex Claims Restoration for the work approved by the Insurer.

Approval Of Terms and Conditions

Owner Authorization

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