ASSIGNMENT OF BENEFITS, CONTRACT FOR SERVICES

DIRECT PAYMENT AUTHORIZATION, AND HOLD HARMLESS AGREEMENT

Agreement:

I, the Owner/Agent for the job site listed below, authorize Erickson’s Drying Systems, Inc. (Hereinafter sometimes referred to as Erickson’s) to enter my property, furnish materials, supply all equipment and perform all labor necessary to reserve and protect my property from further damage.

Assignment of Insurance Benefits and Direct Payment Authorization:

I hereby assign any and all insurance rights, benefits, and proceeds under any applicable insurance policies to Erickson’s Drying Systems, Inc. I also hereby authorize direct payment of any benefits or proceeds to Erickson’s. I make this assignment and authorization in consideration of Erickson’s agreement to perform services and supply materials and otherwise perform its obligations under this contract, including not requiring full payment at the time of service. I also hereby direct my insurance carrier (s) to release any and all information requested by Erickson’s, its representative, or its attorney to the direct purpose of obtaining actual benefits to be paid by my insurance carrier(s) for services rendered or to be rendered. In this regard, I waive my privacy rights. If payent is made directly to the Owner/Agent by an insurer, it shall be endorsed over to Erickson’s within three business days. I agree that any portion of work, deductibles, betterment, depreciation or additional work requsted by the undersigned, not covered by insurance, must be paid by the undersigned on or before its completion. I hereby appoint Erickson’s as attorney in-fact, authorizing Erickson’s to endorse my name, and to deposit insurance checks or drafts for Erickson’s. Payment terms to Erickson’s are net-30 days. Late charges of 1.5% monthly are charged to any and all unpaid balances. Erickson’s shall be entitled to reimburesement 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, or any terms of this entire service agreement.

Authorized Antimicrobial Agents:

I understand that in the best judgment of Erickson’s, 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 product a part of the restoration process. I understand it is beyond the expertise of Erickson’s to determine if someone is sensitive to its application and will hold Erickson’s harmless for its use.

Stop Work-Hold Harmless:

In the event Erickson’s is not allowed to perform its recommended procedures and/or drying equipment is removed prematurely, I agree to release and hold Erickson’s harmless, and indemnify Erickson’s against all claims or actions that may result from such procedures.