ASSIGNMENT OF BENEFITS, CONTRACT FOR SERVICES

CONTRACT FOR SERVICES, ASSIGNMENT OF BENEFITS

I, the Owner/Agent for the job site listed below, authorize Erickson’s Drying Systems, Inc. (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 Erickson’s Drying Systems, Inc, for services rendered or to be rendered by Erickson’s Drying Systems, Inc. By
executing this document, I intend for all rights, benefits, and proceeds for services rendered by Erickson’s Drying Systems,
Inc to be assigned solely and exclusively to Erickson’s Drying Systems, Inc. In this regard, I waive my privacy rights. I
make this assignment in consideration for Erickson’s Drying Systems, Inc’s 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 Erickson’s Drying
Systems, Inc, 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
Erickson’s Drying Systems, Inc to be made payable solely to Erickson’s Drying Systems, Inc and sent exclusively to
Erickson’s Drying Systems, Inc. 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 product 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

Sending

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