North Carolina LOR

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Name*
First Last
Phone*
Email
Address*
Street Address Address Line 2 City State ZIP Code
Homeowner's Insurance Company*
Policy Number*
Claim Type*
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- Catastrophe
- Non-Catastrophe
Date of Loss*
Date Format: MM slash DD slash YYYY
Claim Number
Cause of Loss
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Flood
Letter of Representation

FEMA 400 C Street SW, 3rd Floor SW Washington DC 20472-3010

Authorized Representative: Bulldog Adjusters Inc.

To Whom It May Concern,
I expressly grant permission to FEMA to release my records to this third-party representative.

"I declare under penalty of perjury that the foregoing is true and correct."
(Pursuant to 28 U.S.C.S 1746).
County of*
Name*
First Last
Executed on*
Date Format: MM slash DD slash YYYY
Signature*
Public Adjuster Contract
Public Adjuster Contract

The undersigned (the Insured) hereby retains the above Public Insurance Adjuster, Aaron Singer (the PA), licensed and bonded pursuant to state law, to be the Insured's representative in the adjustment of the above referenced loss under the following terms: The Insured hereby agrees to pay to the PA an amount equal to 20% of the gross amount of the collected loss or damage recovered regardless of whether the loss is settled or paid by the insurance company or by reason of the above referenced policy as a result of adjustment, mediation, appraisal, arbitration, lawsuit or otherwise, on all coverage applicable under the referenced policy or any other applicable policy, including, without limitation, claims for bad faith and extra contractual damages or loss (hereafter referred to as the "PA fee"). If no recovery is made, the Insured will not be indebted to the PA for any sum of fees.

The Insured hereby authorizes the PA to contact the above-named insurance company to direct them to include the name of Aaron Singer as a payee on any and all insurance proceeds checks issued by reason of the above referenced loss. This provision shall remain in full force and effect unless revoked by mutual written agreement of the insured and PA.

Payment to the PA shall be due and payable in full at the time that insurance proceeds are paid or issued by the insurance company. In consideration for the PA's professional services, the Insured by this agreement hereby irrevocably assigns to the PA, and the PA shall have a lien on, the portion of the insurance proceeds paid or payable sufficient to pay the amount due the PA under the agreement. In the event legal proceedings are brought by the PA to enforce this agreement, the prevailing party shall be entitled to recover its court costs and reasonable attorney’s fee, including those of any appellate proceedings. Venue for all legal proceedings to be held in the courts of Broward County, Florida.

This contract may be cancelled by written notification to the PA, sent by certified mail, return receipt requested or other form of mailing which provides proof thereof, at any time within three (3) business days of the date the contract was signed, as shown above, and if canceled the Insured shall not be obligated to pay any fees to the PA, for the work performed during that time. If the PA has advanced funds or has made payments on behalf of the Insured to others, in representation of the insured, the PA, is entitled to be reimburse for such amounts as it has reasonably advanced on behalf of the Insured. In the event that this contract is canceled by the Insured after three (3) business days, then the PA shall have a retaining lien and charging lien for work performed and costs advanced. Furthermore, the PA will not be held liable in any way for any filed claims on the property which were canceled by the Insured. If the insured exercises the right to rescind the contract, anything of value given by the insured under the contract will be returned to the insured within 15 business days after the receipt by the public adjuster of the cancellation notice. The Insured hereby authorizes the PA to hire the professional services of appraisers, umpires, estimators, engineers, and any other experts as may be deemed necessary by the PA. Any costs associated with said claims recovery will be reimburse to the PA. The Insured must consent to the cost prior to the PA hiring said professional(s). The Insured understands that it is responsible to pay the PA its fee, out of any and all insurance proceeds, prior to any payments to anyone else, including but not limited to mortgage companies, insurance companies, lenders, creditors, or any third parties, of any kind, or any other individual or corporation. The Insured hereby agrees that the Insured is solely responsible to timely obtain any and all mortgage endorsements necessary of said payments/checks so as to release payments to the PA. The PA shall in no event be obligated to conform to mortgage company requirements, in order to receive agreed to fee payments, and or out of pocket reimbursements.

The Insured acknowledges that the PA has made no guarantees regarding the disposition or results of any stage of the claims process and all expressions made on behalf of the PA are the opinion of the PA based on information known at that time.

The Insured represents that all information given to the PA is true and accurate.
Insured Signature*
Date*
Date Format: MM slash DD slash YYYY
Public Adjuster Signature
Date
Date Format: MM slash DD slash YYYY
Source (to be filled out by adjuster)
Adjuster Name*
Hurricane
Public Adjuster Contract | Hurricane

The undersigned (the Insured) hereby retains the above Public Insurance Adjuster, Aaron Singer (the PA), licensed and bonded pursuant to state law, to be the Insured's representative in the adjustment of the above referenced loss under the following terms: The Insured hereby agrees to pay to the PA an amount equal to 10% of the gross amount of the collected loss or damage recovered regardless of whether the loss is settled or paid by the insurance company or by reason of the above referenced policy as a result of adjustment, mediation, appraisal, arbitration, lawsuit or otherwise, on all coverage applicable under the referenced policy or any other applicable policy, including, without limitation, claims for bad faith and extra contractual damages or loss (hereafter referred to as the "PA fee"). If no recovery is made, the Insured will not be indebted to the PA for any sum of fees.

The Insured hereby authorizes the PA to contact the above-named insurance company to direct them to include the name of Aaron Singer as a payee on any and all insurance proceeds checks issued by reason of the above referenced loss. This provision shall remain in full force and effect unless revoked by mutual written agreement of the insured and PA.

Payment to the PA shall be due and payable in full at the time that insurance proceeds are paid or issued by the insurance company. In consideration for the PA's professional services, the Insured by this agreement hereby irrevocably assigns to the PA, and the PA shall have a lien on, the portion of the insurance proceeds paid or payable sufficient to pay the amount due the PA under the agreement. In the event legal proceedings are brought by the PA to enforce this agreement, the prevailing party shall be entitled to recover its court costs and reasonable attorney’s fee, including those of any appellate proceedings. Venue for all legal proceedings to be held in the courts of Broward County, Florida.

This contract may be cancelled by written notification to the PA, sent by certified mail, return receipt requested or other form of mailing which provides proof thereof, at any time within three (3) business days of the date the contract was signed, as shown above, and if canceled the Insured shall not be obligated to pay any fees to the PA, for the work performed during that time. If the PA has advanced funds or has made payments on behalf of the Insured to others, in representation of the insured, the PA, is entitled to be reimburse for such amounts as it has reasonably advanced on behalf of the Insured. In the event that this contract is canceled by the Insured after three (3) business days, then the PA shall have a retaining lien and charging lien for work performed and costs advanced. Furthermore, the PA will not be held liable in any way for any filed claims on the property which were canceled by the Insured. If the insured exercises the right to rescind the contract, anything of value given by the insured under the contract will be returned to the insured within 15 business days after the receipt by the public adjuster of the cancellation notice. The Insured hereby authorizes the PA to hire the professional services of appraisers, umpires, estimators, engineers, and any other experts as may be deemed necessary by the PA. Any costs associated with said claims recovery will be reimburse to the PA. The Insured must consent to the cost prior to the PA hiring said professional(s). The Insured understands that it is responsible to pay the PA its fee, out of any and all insurance proceeds, prior to any payments to anyone else, including but not limited to mortgage companies, insurance companies, lenders, creditors, or any third parties, of any kind, or any other individual or corporation. The Insured hereby agrees that the Insured is solely responsible to timely obtain any and all mortgage endorsements necessary of said payments/checks so as to release payments to the PA. The PA shall in no event be obligated to conform to mortgage company requirements, in order to receive agreed to fee payments, and or out of pocket reimbursements.

The Insured acknowledges that the PA has made no guarantees regarding the disposition or results of any stage of the claims process and all expressions made on behalf of the PA are the opinion of the PA based on information known at that time.
The Insured represents that all information given to the PA is true and accurate.
Insured Signature*
Date*
Date Format: MM slash DD slash YYYY
Public Adjuster Signature
Date
Date Format: MM slash DD slash YYYY
Source (to be filled out by adjuster)
Adjuster Name*
Disclosure Statement

Property insurance policies obligate the insured to present a claim to his or her insurance company for consideration. There are three types of adjusters that could be involved in that process. The definitions of the three types are as follows:

“Company adjuster” means the insurance adjusters who are employees of an insurance company. They represent the interest of the insurance company and are paid by the insurance company. They will not charge you a fee.

“Independent adjuster” means the insurance adjusters who are hired on a contract basis by an insurance company to represent the insurance company's interest in the settlement of the claim. They are paid by your insurance company. They will not charge you a fee.

“Public adjuster” means the insurance adjusters who do not work for any insurance company. They work for the insured to assist in the preparation, presentation, and settlement of the claim. The insured hires them by signing a contract agreeing to pay them a fee or commission based on a percentage of the settlement or other method of compensation.

The insured is not required to hire a public adjuster to help the insured meet his or her obligations under the policy but has the right to do so.

The insured has the right to initiate direct communications with the insured's attorney, the insurer, the insurer's adjuster, and the insurer's attorney, or any other person regarding the settlement of the insured's claim.

The public adjuster is not a representative or employee of the insurer.
The salary, fee, commission, or other consideration is the obligation of the insured, not the insurer.
By signing this document I acknowledge that I have read and understand the information provided in this disclosure statement.

Notification of Representation

Aaron Singer
NC Lic # 0012250685
6950 Cypress Road STE 300
Plantation, FL 33317
786-230-4741

This letter serves as notification of representation for the below mentioned policy holder. The policy holder has entered into a contract with public adjuster, Aaron Singer. All future communications will be held by the office of Aaron Singer. The policyholder has 3 business days from the signed date to cancel this contract.
Insured Signature*
Date*
Date Format: MM slash DD slash YYYY
Public Adjuster Signature
Date
Date Format: MM slash DD slash YYYY
Catastrophe
Insured's Name:*
First Last
Loss Address:*
Street Address Address Line 2 City State ZIP Code
Insurance Company:*
Policy Number:*
Date of Loss:*
Cause of Loss:*
The undersigned (the Insured) hereby retains the above Public Insurance Adjuster (the PA), licensed and bonded pursuant to state law, to be the Insured's representative in the adjustment of the above-referenced loss under the following terms:

The Insured hereby agrees to pay to the PA an amount equal to 10% of the gross amount of the collected loss or damage recovered regardless of whether the loss is settled or paid by the insurance company or by reason of the above-referenced policy as a result of adjustment, mediation, appraisal, arbitration, lawsuit or otherwise, on all coverage applicable under the referenced policy or any other applicable policy, including, without limitation, claims for bad faith and extra-contractual damages or loss (hereafter referred to as the "PA fee"). If no recovery is made, the Insured will not be indebted to the PA for any sum of fees.

The Insured hereby authorizes the PA to contact the above-named insurance company to direct them to include the name of Bulldog Adjusters as a payee on any and all insurance proceeds checks issued by reason of the above-referenced loss. This provision shall remain in full force and effect unless revoked by mutual written agreement of the insured and PA.

Payment to the PA shall be due and payable in full at the time that insurance proceeds are paid or issued by the insurance company. In consideration for the PA's professional services, the Insured by this agreement hereby irrevocably assigns to the PA, and the PA shall have a lien on, the portion of the insurance proceeds paid or payable sufficient to pay the amount due to the PA under the agreement. In the event legal proceedings are brought by the PA to enforce this agreement, the prevailing party shall be entitled to recover its court costs and reasonable attorney’s fee, including those of any appellate proceedings. Venue for all legal proceedings to be held in the courts of Broward County, Florida.

This contract may be canceled by written notification to the PA, sent by certified mail, return receipt requested or other form of mailing which provides proof thereof, at any time within three (3) business days of the date the contract was signed, as shown above, and if canceled the Insured shall not be obligated to pay any fees to the PA, for the work performed during that time. If the PA has advanced funds or has made payments on behalf of the Insured to others, in the representation of the insured, the PA, is entitled to be reimbursed for such amounts as it has reasonably advanced on behalf of the Insured. In the event that this contract is canceled by the Insured after three (3) business days, then the PA shall have a retaining lien and charging lien for work performed and costs advanced. Furthermore, the PA will not be held liable in any way for any filed claims on the property which were canceled by the Insured. If the insured exercises the right to rescind the contract, anything of value given by the insured under the contract will be returned to the insured within 15 business days after the receipt by the public adjuster of the cancellation notice.

The Insured hereby authorizes the PA to hire the professional services of appraisers, umpires, estimators, engineers, and other experts as may be deemed necessary by the PA. Any costs associated with said claims recovery will be reimbursed to the PA. The Insured must consent to the cost prior to the PA hiring said professional(s). The Insured understands that it is responsible to pay the PA its fee, out of any and all insurance proceeds, prior to any payments to anyone else, including but not limited to mortgage companies, insurance companies, lenders, creditors, or any third parties, of any kind, or any other individual or corporation. The Insured hereby agrees that the Insured is solely responsible to timely obtain any and all mortgage endorsements necessary of said payments/checks so as to release payments to the PA. The PA shall in no event be obligated to conform to mortgage company requirements, in order to receive agreed to fee payments, and or out of pocket reimbursements.

The Insured acknowledges that the PA has made no guarantees regarding the disposition or results of any stage of the claims process and all expressions made on behalf of the PA are the opinion of the PA based on information known at that time.

The Insured represents that all information given to the PA is true and accurate.

ADDITIONAL INSURED (if any- cross out if none)
Insured Name:*
First Last
Insured Signature:*
Date*
Insured Name:
First Last
Insured Signature:
Date
Bulldog Adjusters of North Carolina, INC.
Name and License Number:*
Public Adjuster Signature:*
Date*
Disclosure Statement
Property insurance policies obligate the insured to present a claim to his or her insurance company for consideration. There are three types of adjusters that could be involved in that process. The definitions of the three types are as follows:

“Company adjuster” means the insurance adjusters who are employees of an insurance company. They represent the interests of the insurance company and are paid by the insurance company. They will not charge you a fee.

“Independent adjuster” means the insurance adjusters who are hired on a contract basis by an insurance company to represent the insurance company's interest in the settlement of the claim. They are paid by your insurance company. They will not charge you a fee. “Public adjuster” means the insurance adjusters who do not work for any insurance company. They work for the insured to assist in the preparation, presentation, and settlement of the claim. The insured hires them by signing a contract agreeing to pay them a fee or commission based on a percentage of the settlement or other methods of compensation.

The insured is not required to hire a public adjuster to help the insured meet his or her obligations under the policy but has the right to do so.

The insured has the right to initiate direct communications with the insured's attorney, the insurer, the insurer's adjuster, and the insurer's attorney, or any other person regarding the settlement of the insured's claim.

The public adjuster is not a representative or employee of the insurer.

The salary, fee, commission, or other consideration is the obligation of the insured, not the insurer.

By signing this document I acknowledge that I have read and understand the information provided in this disclosure statement.
Signature of Insured:*
Date*
Notification of Representation

Bulldog Adjusters of North Carolina, INC
NC LIC # 1000638204
Name and License Number:*
6950 Cypress Road STE 300
Plantation, FL 33317
786-230-4741
Homeowner Name:*
First Last
Address:*
Street Address Address Line 2 City State ZIP Code
Insurance Company:*
Policy Number:*
Claim Number:*
This letter serves as notification of representation for the below mentioned insured. The insured has entered into a contract with public adjuster, Bulldog Adjusters of North Carolina. All future communications will be held by the office of Bulldog Adjusters of North Carolina. The insured has three (3) business days from the signed date to cancel this contract.
Insured's Signature:*
Date*
Public Adjuster Signature:*
Date*

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