Insurance Agreement

This form is an agreement between Quinlan Tree Service, and the client (named property owner/insured below). To perform emergency tree removal from the property, that is covered under their insurance policy, held in agreement with the Insurance Company (named below). Giving the assignee (Quinlan Tree Service) permission to collect on payment directly from the insurance company based on the covered peril listed in the policy. What is the customer's preferred form of contact: *

Name of Insurance Company *

Please provide us with the claim number on file associated with this claim: Claim number. (If the client does not have a claim number you cannot proceed until they get one). Please list any obvious hazards or barriers (ditches, power lines, overhead dangers, septic tanks and fields, any know underground lines). *

Contract between Quinlan Tree Service, and the client that is signing include the following items documents: Estimate of the costs of the work to be performed, set out as a minimum 8 hours for our services based upon the crew doing the work, with the 8 hour minimum multiplied by 2 due to Emergency provisional work, which caused us to set aside other scheduled work in order to perform immediate emergency work. The list of the rates the insured/insurance company will be charged for any equipment we use to perform the work on the clients property. This ensures the clients know the potential for the actual invoice based on our rates for works performed. The agreed upon format for payment and billing that was explained to the customer at the time of this contract being signed by the parties and entering an agreement for the work to be performed to allow Quinlan Tree Service to do the emergency tree removal from the clients property. This customer has agreed to allow Quinlan Tree Service to invoice and bill the client's insurance company for any portion of the outstanding bill for the services provided to the insured's property in order to ensure the (client/customer) is compliant with their responsibility to prevent further loss due to the insured covered peril. The customer is granting permission of the carrier to remit payment for this claim to Quinlan Tree Service, for the total amount invoiced below. In compliance with many state laws, we are advising the client that they are waiving the right to the provision in the law that allows them to have three days to decide if they would like to cancel an agreement for work or not. The client (named below has been advised of this). First name Last name By signing this, I (the policyholder/insured/client) acknowledge I have been advised I am waiving my right to the three day provision concerning cancellation of the agreed upon contract allowing for the removal of the insured covered peril from my property. That I (the policy holder) am also able to cancel at any time prior to the job actually beginning with no penalty. *

Terms and conditions: 1.) Customer's Obligations: The customer agrees that Quinlan Tree Service will be able to perform the duties pertaining to the job agreed upon between the hours of 9 AM and 5 PM Monday-Friday or hours that the customer agrees with based on emergency removal. Customer agrees to provide Quinlan Tree Service access to the property to perform the agreed upon work. The customer accepts responsibility for reimbursement to Quinlan Tree Service. Customer expressly agrees to help Quinlan Tree Service get paid by the carrier. Any legal fees arising from nonpayment or checks held will be responsibility of the homeowner. Any proceedings involving collection will be held in Oakland County Michigan court system. Quinlan Tree Service is not responsible for work delays that are due to inclement weather or other acts of God. Quinlan Tree Service is not responsible for protection of customer's property. Customer agrees to hold Quinlan Tree Service harmless from damages that may arise from standard industry practices concerning emergency tree removal due to equipment, delivery of materials, and/or storage of materials. Quinlan Tree Service and their associates will do their best to advise and consult the customer prior to potential damaging situations as they are identified. (Such as cracking of driveways, damage to landscaping, or yards due to equipment and job performance.) Customer agrees to indemnify and hold the assignee harmless from any damage or injury caused by any debris on the property that is not the result of work or negligence of the contracted crews assigned to the job. Quinlan Tree Service nor their associates shall be expected to keep gates or doors closed or lock and customer agrees to indemnify and hold them harmless from claims arising there from. 2.) Protection of property: The customer agrees they will have removed, stored and/or protected any and all personal property, including vehicles, prior to and during the work. The customer accepts responsibility for and agrees to hold Quinlan Tree Service harmless from any damages to personal property that is the result of the customers failure to do the above. Quinlan Tree Service will not be held responsible for damages to driveways, curbing, and/or gutters at the property during the work, that is not due to negligence. The customer understands and accepts that heavy equipment such as cranes, trucks and other industry standard machines due to weight and performance of the jobs is likely to cause cracking, or fractures in concrete or troughs in asphalt, Quinlan Tree Service will take all precautions to protect this from happening, yet will not be responsible for repair or replacement due to anything other than negligence on our part that results in damage to driveways, landscaping, yards, or slight scratching or denting of gutters, or oil droplets in driveways. 3.) Insurance: Quinlan Tree Service agrees to maintain general liability and worker's compensation insurance coverage obligations as required by law on its employees working on the job site. By initialing here and signing below, I agree that I have been advised on the terms and conditions above. *

to like Quinlan

Date Signed *

I hereby authorize my insurance company to process payment of this claim and issue payment for work performed by Quinlan Tree Service as the "assignee". This is an assignment of a claim for damages, for emergency tree work being made effective as of Date Signed Between: The policyholder/Insured/homeowner First name Last name Where the work for the peril resulting in loss, location of work being performed: *

Street Address *

City *

State *

Zip Code *

Emergency Tree Work: Insurance Company Name *

Claim Number *

Adjusters Name *

Adjusters Number *

Adjusters Email *

Date of Loss *

I authorize, Insurance Company directly, on Claim Number Signature Needed. I acknowledge that I am giving "the assignee" permission to contact my insurance company to solve any errors or omissions in my policy or claim. I am giving the "assignee" full permission to ask for and receive policy specific language and limitations from the carrier. *

Dated *

Emergency Storm Rates: Below is our rate schedule for emergency work. We define emergency work that is not scheduled at least 3 weeks in advance. The customer is expressly stating that they deem the scope of work as an emergency and are asking that the work be performed immediately. All rates are an 8 hour minimum, which is standard in the industry. Normal hours are 9am to 5pm. Any work , including port to port are charged at 2 times the standard hourly rate. All rates will be the actual time on site, plus 1 hour travel each way, commonly called port to port travel, but not less than 8 hours. This time allows for equipment set up, tear down, trip inspections, and travel time. Below is our most common equipment and fees, but is not limited to this list. Again, all rates are based on our minimum 8 hour rate for storm work. Any work that goes over 8 hours will be increased over these rates listed at the amount of 12.5% per hour unless otherwise specified. *

Emergency Tree related call: An administration and assessment fee for initial consult and billing fees. $350.00. Sign Initials

Mini Skid Steer: Used for moving heavy material safely and efficiently to cut down on crane time operation. $250.00 per hour. Sign Initials

Skid Steer: Used for moving heavy material safely and efficiently to cut down on crane operation time. $250.00 per hour. Sign Initials

Laborer (per person): Worker assisting with saws, rigging, moving debris, spotters, and other necessary tasks. $125.00 per hour. Sign Initials

Forestry Bucket Truck: To assist in removing the debris and or peril from hard to access locations. $250.00 per hour. Sign Initials

Log Truck: A vehicle used in addition to the above equipment, support vehicle for the purpose of hauling logs. $400.00 per hour. Sign Initials

Wood Chipper: Used for removal of brush. $250.00 per hour. Sign Initials

Chip Truck: Used for hauling chips. $250.00 per hour. Sign Initials

22 Ton Boom Crane: Used in removal of tree and peril from the covered structure. $600.00 per hour. Sign Initials

38 Ton Boom Crane: Used in removal of tree and peril from the covered structure. $800.00 per hour. Sign Initials

Service Truck (per unit not specified): Vehicle used in addition to the above equipment, support vehicle for the purpose of assisting personnel or equipment. $200.00 per hour. Sign Initials

Ground protections/skid matting per unit (per unit rate): Used to protect ground surfaces. $20.00 per mat used. Sign Initials

Debris Hauling covers material removed from the curb to an approved disposal location. 10% of all equipment and labor. Sign Initials

ATTENTION!!!! The above section is our rate schedule. WE CANNOT SUPPLY A FINAL TOTAL UNTIL ALL SERVICES ARE RENDERED, as all jobs are different in scope, size and difficulty. We have attempted to convey the estimated cost of the job, however this is an estimate and is just based on the salesman's observations and interpretation. Which may be different than the actual needs we determine once the operators and site supervisors arrive and assess the hazards, barriers and scope of the job. This form is being used to simply show you the estimated costs of the equipment that will be used in the removal of the tree/debris during this job. In the event that there is a discrepancy in the value of service, the customer will assist Quinlan Tree Service in seeking appraisal for the value of services received. Sign Initials

General Acceptance of Terms: I acknowledge that I have read, and accept all the terms and conditions contained in this agreement. In the event the insurance or adjustment company inadvertently mails the settlement/supplement check to me in error, I hereby agree to notify the "assignee" and execute means to delivery the amount either directly or in personal form to: Quinlan Tree Service 1214 Enterprise Drive Highland, MI 48357 At this time, Quinlan Tree Service would like to thank you! We would like to take a moment to state we appreciate you allowing us to serve you, and assist you in your time of need, and apologize for the circumstances that have brought us together and express, and stress that we understand the situation and what it is you are experiencing. Please contact us with any questions regarding this invoice. Forms of payment accepted are cash and check. Quinlan Tree Service reserves the right to add a late fee of $35 and a finance charge of 10%/month added to unpaid past due balances. For credit card payments Quinlan Tree Service reserves the right to add a 10% charge for added expenses. Payment ensures services have been completed in full and no other services have been promised. Client acknowledges complete and total satisfaction of service provided. Acceptance of partial payment in no way negates the balance due. No reductions, corrections, invoice adjustments, or changes of any kind by the assignee are an act of insurance adjusting or advising of any kind. Audits and inquiries are subject to fees for billable hours at a rate of $100 per hour. Sign Initials

Authorized Signature To Perform Emergency Work *

Insurance Agreement

Payment can be mailed to:

Quinlan Tree Service
1214 Enterprise Drive
Highland, MI 48357

Phone number:
(248) 363-8500

Insurance Agreement

Payment can be mailed to:

Quinlan Tree Service1214 Enterprise DriveHighland, MI 48357

Phone number:(248) 363-8500

Quinlan Tree Service
1214 Enterprise Drive
Highland, MI 48357

Phone number:
(248) 363-8500