AUTHORIZATION TO PROCEED WITH WORK

I understand that First General is an independent contractor who is neither an agent nor an employee of my Insurer. I further understand that I am under no obligation to utilize this contractor’s services to complete any repairs, that I may select a contractor of my choice and that the selection of First General is not a condition of indemnity of my Claim.

I hereby authorize First General, a contractor approved by my Insurer, to proceed with work necessary to mitigate the onset of additional damages and to commence and carry out the approved insurance loss-related repairs at my property insured by the terms and conditions as set out in my policy.

In the event that any additional services or work not contemplated becomes necessary, I understand that the contractor shall then identify those services and/or work by written communication to be approved by my Insurer and myself. If this procedure is not complied with, I understand that no additional work is authorized and payments for such work will be my responsibility.

I agree that the applicable deductible as indicated below or any other amount that is not covered by my insurance policy will be paid to the contractor upon request or as invoiced. I also agree to pay the contractor any amounts that are received directly from my Insurer for the approved insurance loss-related repairs upon completion of these repairs.

I understand that the workmanship completed by contractor is warranted for a period of three (3) years from the date the approved insurance loss-related repairs are completed.

Loss Date (required)Example Format: 2016-05-30

Insured Name (required)

Email (required)

Loss Address (required)

Insurance Company (required)

Claim #

Authorized By

Policyholder Name (required)

Policyholder Signature (required, click or tap to draw your signature)

Date Signed (required)

Deductible Amount