Connecticut LOR

INFORMATION ABOUT YOUR PUBLIC ADJUSTER EMPLOYMENT CONTRACT

YOUR LEGAL RIGHTS:

Cancellation: You may cancel this contract by notifying us at the address shown on the other side of this page, in writing, by certified mail, return receipt, postmarked not later than midnight two (2) days following the day this contract is signed. If the contract is signed on a Friday, Saturday or Sunday, you will have until midnight on the following Tuesday to mail the notice of cancellation to us as described above.
Settlement offer: We shall forward to you any written settlement offer from the insurance company.
Fee: Our services are available for a fee to be paid by you. We cannot charge you a fee greater than ten percent (10%) of the actual or final settlement of the loss covered by this contract nor can we rebate any part of the fee specified in this Employment Contract.
Copy of the contract: We must give you a true copy of this Employment Contract at the time you sign it.
LIMITATIONS OF PUBLIC ADJUSTERS:
We are not allowed:
__to solicit your employment between 8:00 p.m. and 8:00 a.m.
__to solicit your employment if you have already hired or contracted with another public adjuster.
__to have any interest whatsoever in any construction, salvage, or appraisal business.
__to represent both an insurer and an insured at the same time.
__to pay anything of value to any person as an inducement to refer business to us.
__to share our fee, except with another licensed Public Adjuster.
__to advise you on any question of law.
__to advance any monies to you before the settlement of the loss, where such amount would be included in the final settlement.
__to make false statements about an insurance company or its representatives.
We must:
__sign this Contract.
__inform you that we do not represent any insurance company or any insurance company adjusting firm.

Bulldog Adjusters of Connecticut, INC.
LIC # 2634277
HQ: 6950 Cypress Road STE 300
Plantation, FL 33317
Phone 877-737-7764 Fax 877-772-0392
claims@bulldogadjusters.com

Aaron Singer LIC# 2624261
Vincent Lefton LIC#2624238
Isabel Solorzano LIC# 2624254
Pinchus Morozow LIC# 2629009
Public Adjuster*
Type of Loss:*
Address of Loss:*
Street Address Address Line 2 City State ZIP Code
Date of Loss:*
I/we retain
to act as my/our public adjuster(s) and to advise and assist in the adjustment and settlement of my/our
loss at

Street Address Address Line 2 City State ZIP Code
which occurred on or about
In consideration for these services, I/we hereby assign out of the monies due or to become due from said Insurance Companies on account of the said loss a sum equivalent to 10% percent of the amount of the loss when adjusted with the Insurance Companies or otherwise recovered.
Date:*
Signature of Insured:*
Signature of Insured:
Name*
First Last
Current Address Same As Address of Loss?
Yes
No
Address*
Street Address Address Line 2 City State ZIP Code
Address*
Street Address Address Line 2 City State ZIP Code
Agreed to:*
Name of individual or firm licensee
By: Signature of public adjuster*
I HAVE READ BOTH SIDES OF THIS CONTRACT.

This form is in compliance with Section 38a-788-6 of the Regulations of the Connecticut Insurance Department. This form must be signed by the licensed Public Adjuster and by Insured.
A checklist making sure everything has been discussed at the property before initiating the process.
The Below Has Been Discussed With The Insured:
Policy Benefits/Exclusions Explained
Overview of the Claim Process
Claim Processor Assigned to your file
Our Fee
Mortgage Process/ICS
Insured's Signature*
Date*
Date Format: MM slash DD slash YYYY
Insured's Signature
Date
Date Format: MM slash DD slash YYYY
Adjuster's Signature*
Date*
Date Format: MM slash DD slash YYYY

INFORMATION ABOUT YOUR PUBLIC ADJUSTER EMPLOYMENT CONTRACT

I HAVE READ BOTH SIDES OF THIS CONTRACT.