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Hurricane
Water
Roof Leak
Flood
Pipe Burst
Fire
Power Surge
Wind
Storm Damage
Hail
File Online
Public Adjusting Contract
Connecticut
Florida
Georgia
New Jersey
North Carolina
Rhode Island
South Carolina
Power of Attorney
Mortgage Authorization
Credit Authorization
Contact
Testimonials
About Us
Blog
FAQ
Connecticut LOR
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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
*
Aaron Singer LIC# 2624261
Vincent Lefton LIC#2624238
Isabel Solorzano LIC# 2624254
Pinchus Morozow LIC# 2629009
Type of Loss:
*
Address of Loss:
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Date of Loss:
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
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20
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22
23
24
25
26
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28
29
30
31
Year
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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:
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
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