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Filing # 135616687 E-Filed 09/29/2021 10:14:58 PM
IN THE SMALL CLAIMS DIVISION OF THE Ninth JUDICIAL CIRCUIT
IN AND FOR Osceola COUNTY, FLORIDA
Loss Restorations LLC, Case No.:
a/a/o Leones Descollines and Louise Jean Kelly,
Plaintiff(s)
vs. Defendant 1: Defendant 2:
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA
Defendant(s)
Address: Address:
STATEMENT OF CLAIM
Plaintiff(s) sue(s) the Defendant(s) for damages which do not exceed $8,000.00 exclusive of
costs and interest for (check one category below):
[4 Auto Accident occurring on or about, in the vicinity of , in,
County, Florida caused by the negligent operation of a vehicle operated by _
and owned by resulting in damages, described below.
( Goods sold by Plaintiff; goods and prices and credits listed below.
CO Work done and materials furnished; time and materials, showing charges and credits, listed
below.
[{) Money lent to defendant on with interest owed since
[J Promissory Note executed on , copy attached; defendant failed to either pay the
note or an installment payment, and interest is owed since , plus attorney's fees.
C2 Account Stated for an agreed balance owed on business transactions between the parties, the
defendant did not object to the statement of account presented, a copy of which is attached.
Other claim — Please specify; Breach of Contract - Monies Owed
Explain below the details (what happened, dates, times, place, etc.) of your claim. This section must be
completed. Attach additional pages if needed.
Please see attached Complaint
Attached is a copy of any written document(s) that is that basis of this claim.
WHEREFORE, the Plaintiff(s) demand judgment in the principal sum of $ [$2,973.15
Plus costs, if known, (summons, service) in the amount of $
Plus interest in the amount of $
TOTAL $ [$2,973.15
Plaintiff Address: Signature of Plaintiff(s)
CJ Law Firm PA Carlos J. Camejo-
6900 Tavistock Lakes Blvd, Suite 400 Print namé of Plaintiff(s)
Orlando, Florida 32827
Telephone No. Title (if applicable)
Email Addresses: {@ojlawfirmpa.com
IN THE COUNTY COURT IN AND FOR
OSCEOLA, FLORIDA
SMALL CLAIMS
CASE NUMBER:
LOSS RESTORATIONS LLC,
a/a/o Leones Descollines and Louise Jean Kelly,
Plaintiff
VS.
AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA,
Defendant.
STATEMENT OF THE CLAIMS/COMPLAINT AND DEMAND FOR.
JURY TRIAL
Plaintiff, LOSS RESTORATIONS LLC., a/a/o Leones Descollines and Louise Jean
Kelly, by and through the undersigned counsel sues the Defendant, AMERICAN INTEGRITY
INSURANCE COMPANY OF FLORIDA, a Florida profit corporation, and alleges:
GENERAL ALLEGATIONS
1 This is an action for damages less than eight-thousand ($8,000.00), so as to be
within the jurisdictional limits of this court, but, exclusive of interest, attorney's fees, and costs.
2. Plaintiff, LOSS RESTORATIONS LLC., a/a/o Leones Descollines and Louise
Jean Kelly, is a Florida Profit Corporation doing business in the county of this Court.
3 The Defendant, AMERICAN INTEGRITY INSURANCE COMPANY OF
FLORIDA, is a Florida insurance company authorized to do and actually conducting insurance
business in county of this Court.
4 Defendant issued an insurance policy to Leones Descollines and Louise Jean
Kelly (“Insured/Assignor”), (Policy No.: AGH0076566 and Claim No.: CHO-00101198)
affording residential property and casualty insurance coverage for the property located at 125
Harness Ln, Kissimmee, FL 34743. A copy of the policy is presently unavailable to the
Plaintiff, but Defendant retains a copy of same.
5 Insured/Assignor paid the premium charged by Defendant for the coverages
afforded pursuant to the terms of the policy, and the policy was in full force and effect on the
date of loss.
6 On or about 08/18/2020, the aforementioned insured property sustained covered
water damages as a result of water damage which caused substantial property damage and
further insured losses.
7 Insured/Assignor submitted a timely claim to Defendant for the alleged
damages and has met all conditions precedent tothe filing of a lawsuit.
8 Plaintiff brings this action as the assignee of Insured/Assignor. A copy of the
assignment is attached hereto as Exhibit “A.”
9 The assignment complies with the requirements of Fla. Stat. 627.7152(2)(a)
insofar as the assignment:
1 is in writing and executed by the assignor and assignee;
ii. contains a provision that allows the assignor to rescind the agreement
without penalty within 14 days of execution, at least 30 days after the date work is scheduledto
commence if assignee has not substantially performed, or at least 30 days after execution ifthe
agreement does not contain a commencement date and the assignee has not begun substantial
work;
iii. contains a provision requiring the assignee to provide a copy of the
executed agreement to the insurer within 3 business days after the date on which the
assignment is executed or the date on which work begins, whichever is earlier;
iv. contains a written, itemized, per-unit cost estimate of services to be
performed by the assignee;
V. relates only to work to be performed by the assignee for services to
protect, repair, restore, or replace a dwelling or structure or to mitigate against further damageto
such property;
vi. contains the following notice in 18-point uppercase and boldface type:
YOU ARE AGREEING TO GIVE UP CERTAIN RIGHTS
YOU HAVE UNDER YOUR INSURANCE POLICY TO A
THIRD PARTY, WHICH MAY RESULT IN LITIGATION
AGAINST YOUR INSURER. PLEASE READ AND
UNDERSTAND THIS DOCUMENT BEFORE SIGNING IT.
YOU HAVE THE RIGHT TO CANCEL THIS AGREEMENT
WITHOUT PENALTY WITHIN 14 DAYS AFTER THE
DATE THIS AGREEMENT IS EXECUTED, AT LEAST 30
DAYS AFTER THE DATE WORK ON THE PROPERTY IS
SCHEDULED TO COMMENCE IF THE ASSIGNEE HAS
NOT SUBSTANTIALLY PERFORMED, OR AT LEAST 30
DAYS AFTER THE EXECUTION OF THE AGREEMENT IF
THE AGREEMENT DOES NOT CONTAIN A
COMMENCEMENT DATE AND THE ASSIGNEE HAS NOT
BEGUN SUBSTANTIAL WORK ON THE PROPERTY.
HOWEVER, YOU ARE OBLIGATED FOR PAYMENT OF
ANY CONTRACTED WORK PERFORMED BEFORE THE
AGREEMENT IS RESCINDED. THIS
AGREEMENT DOES NOT CHANGE YOUR OBLIGATION
TO PERFORM THE DUTIES REQUIRED UNDER YOUR
PROPERTY INSURANCE POLICY.
vii. contains a provision requiring the assignee to indemnify and hold
harmless the assignor from all liabilities, damages, losses, and costs, including, but not limited
and does not contain any prohibited content.
10. Plaintiff, provided necessary, emergency services, construction services, and
other compensable services for Insured/Assignor and in exchange, the Insured/Assignor agreed
to allow direct billing to the insurance carrier, Defendant, and further agreed to assign all rights
under the insurance policy.
11. Defendant, has not been prejudiced by any failure of Plaintiff to maintain
records of all services provided under theassignment agreement, cooperate with the insurer in
the claim investigation, provide the insurer with requested records and documents, or deliver a
copy of the assignment agreement.
12. Plaintiff has provided the Insured/Assignor with accurate and up-to-date revised
estimates of the scope of work to be performed as supplemental or additional repairs are
required, performed work in accordance with industry standards, has not sought payment from
the Insured/Assignor exceeding the deductible unless the Insured/Assignor has chosen to have
additional as submitted to requests for examination under oath and/or recorded statements
and/or participated in appraisal or other alternativedispute resolution, if requested.
13. Plaintiff submitted (a) reasonably priced bill(s) for the servicesto Defendant, for
the alleged damages and has met all conditions precedent to the filing of a lawsuit.
14. Plaintiff provided the named insured, insurer, and the assignor,if not the named
insured, with written notice of intent to initiate litigation before filing suit under this insurance
policy. Such notice was served by certified mail, return receipt requested,or electronic delivery
at least 10 business days before filing suit, but not before coverage was determined. A copy of
said notice is attached hereto as Exhibit “B.”
COUNT I- BREACH OF CONTRACT
15. Plaintiff adopts and incorporates! through 14.
16. Defendant has breached the insurance policy contract by refusing to pay the
full amount of the invoice for Plaintiffs services.
17. Defendant has breached the insurancecontract by failing and refusing to tender
all insurance proceeds due and owing to the Plaintifffor the covered losses sustained to the
Insured/Assignor, and performed and/or paid for by Plaintiff.
18. Alternatively, Defendant has breached the insurance contract by issuing payment
to parties other than Plaintiff to the exclusion of Plaintiff, despite the valid assignment of
benefits and direction to pay.
19. As a result of Defendant, Plaintiff has been deprived of the coverages and other
benefits afforded underthe insurance policy.
20. Asa direct and proximate result of Defendant's aforementioned breach of the
insurance policy contract, Plaintiff has sustained damages for which Plaintiff is entitled to
be indemnified against under the Policy and which were payable to or on behalf of Plaintiff
Insured/Assignor in connection with the loss to Insured/Assignor property
21. Plaintiff has complied with all conditions required to be performed, and/or
have been excused from performance of any conditions by the conduct of Defendant, and/or
said conditions have otherwise been waived.
22. As a further result of Defendant’s breach ofcontract, Plaintiff has been forced
to retain undersigned counsel for this action and it is entitled to a reasonable attorneys fees
thereby pursuant Fla.Stat. 627.428 and modified by Fla. Stat. 627.7152.
WHEREFORE, the Plaintiff, demands judgment against the Defendant and other
relief this Court deems appropriate.
DEMAND FOR JURY TRIAL
23. Plaintiff demands trial by jury of all issues that are triable as a matter of right.
DESIGNATION OF E-MAIL ADDRESS PURSUANT TO RULE 2.516
Pursuant to Florida Rule of Judicial Administration 2.516, Plaintiff hereby files its
notice of designation of email address for the purpose of service of all documents required to
be served in this proceeding: cj@cjlawfirmpa.com.
DATED this September 29, 2021.
CJ LAW FIRM, P.A.
Attorney for Plaintiff
2332 Galiano St., 2nd Floor
Coral Gables, Florida 33134
6900 Tavistock Lakes Blvd, Suite 400
Orlando, FL 32827
Telephone: (305) 728-7049
(321) 274-1298 (Orlando)
Email: cj@cjlawfirmpa.com
E-Service: cj@cjlawfirmpa.com
BY: /s/ CARLOS J. CAMEJO
CARLOS J. CAMEJO, ESQUIRE
Exhibit A
om
&
Emergency Assignment Agreement
; |, Leones Descollines & Louise Jean Kelly the Homeownerinsured, and or its representative for the
property located at 125 Harness Lane , Kissimmes, Florida, 34743, United States (hereinatter “Client’}, authorize
Loss Restorations LLC (hereinafter “Service Provider’) to enter said to perform services to protect, repair.
fesiore, or a ‘of structure or to miligate against further damage to such property. Client and Service
Provider hereby acknowledge that the services lo be provided are being pt ovided in an urgent or emergency circumslance.
Chent agree to fully cooperate with insurance company as required by the s: subject policy of ingurance and comply with alt
postloss duties required by same. Client aiso accepts responsibilty to protect any equipment leftat the subject property
for mitigation and remediation purposes.
; Clent hereby sssign any and all insurance rights, benefits,
and proceeds under my property insurance policy up to the amount of the services provided by Service Provider. Chant
also hereby instructs and directs my insurance carries to make a separate and individual payment to be sent rectly to
Service Provider, ar its representatives for the services in the in the instant matter. Ckent makes this assignment anc
authorization in consideration of Service Provider's agreement to perform services and supply matenals and otherwise
perform its obligations under this contract, including not requiring full payment at the time of service. Chent believes the
appropriate insurance carner to be American Integrity Insurance Company of Florida. Service Provicer shall provide a
copy of the executed assignment agreement to the name insurer withid 2 business days alter the date on which the
Assignment agreement was execul: ed or the date on which work begins, whichever is earber, Delivery of the copy of the
assignment agreement to the insurershail be made by ore of the methods proscnbed in Fis. Stat. § 627.7152. Client also
hereby mstructs my iesurance camer to release any and all information requested by Service Provider its representative,
or its Atlomey solely for the direct purpose of cblaing actual benelts to be paid by my insurance carrier for services:
fendered or to be rendered. Chent hereby assign all legal rights 16 recaver any and all insurance proceeds owed by my
action up to the
insurance company regarding this loss; including but not lamited fo the right to bring appropriate legal
amount owed for the services rendered by Service Provider. Service Provider shall be entited to any and all recovery of
costs, and attorney's fees associated with Ine collection of the: invoice from Chent’s insurance Company as provided lor
under Fla, Stat. § 627.752. Chent has the right to rescind the assignment agreement without @ penalty or tee by
submitting a written notice of rescission signed by Client to Service Provaier within 14 days after the execution of the
ent, at least 30 days alter the date work on the px is scheduled to commence if Service Provider has not
substantially performed. or al least 30 days after the execution ‘of the agreemerit # the agreement does. not contain a
commencement date and the assignee has not begun substantial work on the property.
Pp: sand Interest: if ior any reason payment is made to te Owner/Agent by an insurer for the services
provided by Service Provider ‘under the instant contract, it shall be endorsed over to Service Provider within three (3)
business days. C ent agrees that any portion of work, deductibles. betterment, depreciation of additional work requested
by the undersigned. not covered by insurance, must be paid by the undersigned on or before its. completion. Clent hereby
appoints Service Provide ¢ as attorney in-lact. authorizing Service Proviger to endorse Client's name, and to deposit
insutance checks or cralts for Service Provider. Payment terms to Service Provider ave nel-30 days. in the event that legal
or collection agency proceedings mus! 2 he instluled to recover any amount due, Service Provider shall be entitied to
recover the cost of collections, incluaing. collection agencies, attorney's fee and courts, plus a linance charge of 1.5% per
month to all amounts due. In exchange for this assignment of benefits Service Provider agrees to indemnity and
hold harmless Client trom all liabilities, damages, losses, and costs. including, but not limited to. attorney fees, should the
policy subject to the assignment agreement prohibit, in whole of in part, the assignment ‘ot benelits,
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i: in the event Service Provider is not allowed to perform its recommended remediation
procedures and protocols for any reason beyond its control, Client agrees to release and hold Service Provider harmiess.
and indemnity Service Provider against alt claims or actions that may result from such procedures.
Client has read and understand the information above and have received a copy for my records. This contract Is
intended to be legally binding and contains ail of the terms and conditions
between the parties.
YOU ARE AGREEING TO GIVE UP CERTAIN RIGHTS YOU
HAVE UNDER YOUR INSURANCE POLICY TO A THIRD PAR TY
WHICH MAY RESULT IN LITIGATION AGAINST YOU A
INSURER PLEASE UNDERSTAND THIS
DOCUMENT BEFORE SIGNING IT. YOU HAVE THE RIGHT TO
CANCEL THIS AGREEMENT WITHOUT PENALTY WITHIN 14
DAYS AFTER THE DATE THIS AGREEMENT IS EXECUTED, AT
LEAST 30 DAYS AFTER THE DATE WORK ON THE PROPERTY
1S SCHEDULED TO COMMENCE IF THE ASSIGNEE HAS NOT
SUBSTANTIALLY PERFORMED, OR AT LEAST 30 DAYS
ER THE EXECUTION OF THE AGREEMENT IF THE
AGREEMENT DOES NOT CONTAIN A COMMENCEMENT DATE
AND THE ASSIGNEE HAS NOT BEGUN SUBSTANTIAL WORK
ON THE PROPERTY. HOWEVER, YOU ARE OBLIGATED FOR
PAYMENT OF ANY CONTRACTED WORK PERFORMED
BEFORE THE AGREEMENT IS RESCINDED. THIS AGREEMENT
DOES NOT CHANGE YOUR OBLIGATION TO PERFORM THE
DUTIES REQUIRED UNDER YOUR PROPERTY INSURANCE
POLICY.
Chent Signature:
Client Name:
ms
ec Signature:
‘Gn Behalf of:
Poticy No.
Loss Restorations
AGHOOTESE6 |
Lic
Chent Signature:
‘Chaim No. CHOO0101 198
Client Name: Date: 08-26-2020
Phone: (407) 099-078
doo Site Address: 125 Harness Lane , Kissimmee,
Florida, 34743, United States
Date
of Loss: 08-18-2020
sto oie Catch
es oe
Customer Equipment Responsibility Form
Cilent Name: Leones Descollines & Louise Jean K:
Loss Address: 125 Hamess Lane , Kissimmee, *8Y Date of Loss: 08-18-2020
Florida, 34743, United States
4 LGR Dehumiditiers
sminsiotain 4 Air Scrubber
4
perenne Air Movers
4
rete ea Injection Cabinets
‘Customer has been informed of the fallowing requirements regarding equipment place on the job site.
1 be felt operating at all times. Do not move uniess you contact
“LOSS RESTORATIONS LLC regarding handling procedures. Tuning of equipment will increase time required to
properly dry structure and/or contents, and may cause i
2.A waterdamaged dwelling should maintain a temperature setting thal promotes ideal drying conditions. Leavis
windews or doors open during dehumicification or setting alr conditioning too low may increase drying time and damage
‘Structure and/or contents,
2. Shouk! Client experience any problems with the equipment, client shail shut same off immediately and contact our
office a3 soon as possible.
4. Chent is responsible for damage to, and/or joss of, this equipment while it js in Clent’s care, custody andior control,
including but not limited to loss by theft. vandaksm or disappear: ANCE,
5. It is the Client's responsibility to allow access to the loss location to enable LOSS RESTORATIONS LLC to check on
and pick up the equipment.
6. The above equipment may be picked up between the hours of am, and p.m. Monday through Friday excluding
holidays.
7. The equipment will be connected the electrical system in the dwelling/structure, I shall be the Client's responsibility to
have the electrical system inspected and serviced @ qualified elecincian if nece: ys
8. The Client agrees to hold LOSS RESTORATIONS LLC. theit respective officars, directors, employees, agents and
affiiates harmless and indemnify same from any and all claims. including costs, expenses and attomey’s fees, resulting
from the improper use of equipment by the Clients and/or any defects on the electrical or plumbing systems in the
Clients’ dwelling/structure.
Customer, Leones Descollines & Louise Jean Kelly, and provider LOSS RESTORATIONS LLC acknowledge receipt of
the above documented equipment
in good working order.
fo
oft
Be peat enn
ose 2020Descoltines
Customer Signature:
Louise Jean Kelly
08-26-2020
Customer Signature:
LOSS RESTORATIONS LLC
08-26-2020
wider's Signature:
te
i
7
oo
Certification of Satisfaction
Customer: Leones Descollines& Louise Jean Kelly
Insurance Company: American Integrity insurance Companyof Fionda
Claim No:
Oid our employees present themselves professionally? Yes No
Comments: mec ere
ee
Did Our sub-contractors present themselves professionaily? ‘Yes,
Comments: crn
se
Did LOSS RESTORATIONS LLC, complete the claim in a satisfactory manner?
(Fes)no
How do you rate LOSS RESTORATIONS LLC performance:
LOSS RESTORATIONS LLC Performance
Excellent
The loss or damage for wich this claim has been and restored to my four) full satistaction and | (we) direct and
‘Sur insurance Company to pay LOSS RESTORATIONS LLC, directly tor service rendered,
-
che. wl pus ykled.
Insured/Owner- 08-30-2070, insuredOwner: 08-30-2020
Leones Descolines Louise Jean Katty
te
CG LOSS- RESTORATIONS
Estenate ate: 2020-08-26 10:40:89
Loss Restorations LLC
From: Bilt To:
Loss Restorations LLC ESTIMATE #: EST-000820
Leones Descollines
11018 Grande Pines Circle 125 Hamess Lane
Orlando, FL, 32821 Kissimmee, Florida
34743, United States
FRERGENCY SERVICE
ING BUSINESS
1.00 EA $145.34 $145.34
THERMAL IMAGING SERVICE
1.00 EA $250.00 $250.00
DEHUMIDIFIER, {PER 24 HOUR PERIOD) LARGE
MONITORING - NO
1 Unitls
Per 4 day/s 4.00 UND $125.00 $500.00
ADD FOR DENUMIDIFIER FILTER
1.60 EA $102.35 $102.35
ee AIR FAN/AIR SCRUBBER (24 HR PERIOD)
-
1 Unit/s Per 4 day/s 4.00 UND $120.00 $480.00
apo FOR HEPA FILTER (FOR NEGATIVE AIR
EXHAUST
0.25 UND $185.43 $46.36
AIR MOVER (PER 24 H IOUR PERIOD) - NO MONITORING
1 Univs Per 4 day/s 4.00 UND $32.00 $128.00
WALL CAVITY DRYING. INJ. TYPE (PER 24 HR PERIOD
NO MONIT. )
4.00 UND $ 120.00 $3 480.00
1 Unit’s Per 4 day/s
DRILL HOLES FOR WALL CAVITY DRYING 400 EA $0.65 32.60
EQUIPMENT DECONTAMINATION CHARGE - PER PIECE
OF EQUIPMENT 4.00 UND: $42.00 $ 168.00
EQUIPMENT SETUP, TAKE DOWN, AND MONITORING
{HOURLY CHARGE) 4.00 $50.85 $203.40
WATER EXTRACTION & REMEDIATION TECHNICIAN -
PER HOUR 0.50 $50.88 $25.43
PLASTIC BAG - USED FOR DISPOSAL OF
CONTAMINATED ITEMS 1.00 UND. $3.38 $3.38
CONTENT MANIPULATION CHARGE - PER HOUR 0.67 HR
ADD FOR PERSONAL PROTECTIVE EQUIPMENT- $52.65 $35.10
HEAV' 2.00 EA $18.82 $37.64
APPLY ANTI-MICROBIAL AGENT TO {V} 651.22 SOF $0.34 $221.41
HEPA VACUUMING - LIGHT - (PER SF) 2u074 SOF $0.40 $84.68
GENERAL CLEAN UP ant SOF $0.28 $59.28
Subtotal: $2,972.97
Total: $ 2,972.97
BONES DESCOLLINES - INITIALS {Dd -pare: & |; ut/' Le
LIK
Length:17,17ft | Width: 12,33 ft | Height 6,92ft
Scope Sheet
ZONE 1
TEMP RH% TEMP RH%
Wed 2020-08-26 72,9 63,8 64,7 86,5 56,6 68,9
Thur 2020-08-27 78,6 58,0 62,3 86,9 55,8 68,8
Fri 2020-08-28 78,3 56,1 61,0 87,4 55,6 69,1
Sat 2020-08-29 83,1 48,8 61,3 87,8 55,1 69,5
Sun 2020-08-30 86,9 40,5 60,2 88,0 55,1 69,8
4 a
Zone 1 Equipment Placement
Air mover (per 24 hour period)
~No monitoring Block and pad furniture in room = Deodorize
‘Axial fan air mover - 1 HP (per Large amount
24 hr period)-No monit. Carbon Filter
Drill holes for wall cavity drying
Wall cavity drying-Inj. type (per
Protect - Cover with plastic st. Stage Filter
24 hr period) No monit.
Ozone Machine
‘Air Mover (per 24 hour
period) No monitoring - MR
General Clean Up 211,71
‘Containment trier irlock [Decon.
Chamber
\ehumidifier (per 24 hour period) Remove polyethylene vapor barrier
~No monitoring
Remove wet caiing tiles drywall
Dehumidifier (per 24 hour period) Containment Barrier - tension post- and bag
Large- No monitoring per day
Peel & seal zipper - heavy duty -after Tear out baseboard
Dehumidifier (per 24 hour business hours
period) XLarge - No Cabinet - full height unit - Detach
monitoring
Dehumidifier (per 24 hour
period) XXLarge - No Floor 21474 Cabinet - lower (base) unit - Detach
monitoring Walls 439,51
‘Add for dehumidifier filter Ceiling Cabinet - vanity unit - Detach
Dehumidifier (per 24 hour period) Thermal Fog
Large- No monitoring — MR Countertop - flat laid plastic lam. -
gh
Detach
Countertop - solid surface/granite -
Refrigerator - Detach
Negati air fan/Air ‘uber Detach
(24 hr period) - No monit. Washing machine — Detach Interior door slab only ~ Detach
‘Add for HEPA filter or 0.25 Tear out non-salv floating floor &
negativealr exhaust fan) Diver aleciio~ Dated
bag
Negative Arran] Ar Scrubber Tear out non-salv solid/eng. wood
(24 br period) — MR Dishwasher — Detach
floor & bag
Ti Soubbe Aner Tear out wet drywall, no bagging
‘Internal. Range - freestanding - electric -
Filter Detach
IEPA fiter for TEPRVAC Tear out wet non-salvage opt,
a cuvbag
Plastic bag - used for isposal o Tear out wet non-salv. gluedn. cpt,
Power distribution box contaminated items
cut/bag
HEPA Vacuuming - Light - (PER 2471
Wood floor drying extraction mat
SF) Tear out non-salv. vinyl tile, cut &
(per 24 br prd).No monit.
Dueling « tele = 6" round.
bag
Water Extraction from hard surface
floor Tear out and bag wet insulation
Equipment decontamination Gas Power Generator (Gas
charge- per piece of oa pment Included) Dry Wall Removal
Bag debris for disposal pet bag
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ORIG: Cant App j Loss Restorations 10
5 toss nestanariows INVOICE #: INV-000969
Loss Restorations LLC invnlge Dates O84 L 20ee
rsa: Bai te: INVOICE esi v comme
Loss Restorations LLC Leones Descoltines ChAIRs HGo0I p19
LIOLS Geanete Plage Cacte 2 vets Lae 2 2U200R 18
Retard, 82821 openmee, Flore INSURANCE COMPANY: drneric vegty,
4743 United States limaemce Company OF Ronda
POLICY NUMBER: AunOoTERGG
EMERGENCY SERVICE CAL . DURING BUSINESS HOURS, 100 FA $3850
THERMAL IMAGING SERVICE Lae w& $208 S20ie
DEHUMIDIFIER (PER 24 HOUR PERIOD) LARGE -NO MONITORING. 460 uN YER. Syn.oG
1 Uniys Pera dag’
ADO FOR OEHUMIDIFIER FILTER La i $368.98 $10.35
NEGATIVE AIR FAN AIR SCRUBBER (74 HR PERIODS NO MONIT. he uND Sea, oe Saenne
yUisaePen & aya
ADO FOR HEPA FILYER (FOR NEGATIVE
AIR EXHAUST FAN) ee ue $364) $5.96
AIR MOVER (PER 24 HOUR PERIOD: . NO MONITORING aay Ut S300 Soe 82
LOst/sBera days
‘WALL CAVITY DRYING-INJ. TYPE (PER 24 HR PERIOD}
NO MONIT. Me Sob $4.08
Vrety ‘ePer 4 days
DRILL HOLES FOR WALL CAVITY DRYING 48 fA gob
EQUIPMENT DECONTAMINATION
CHARGE - PER PIECE OF EQUIPMENT Amt oN baz 06 5188.00
EQUIPMENT SETUP, TAKE DOWSE, AND MONITORING (HOURLY CHARGE) aoe ate $90.85 oaonae
WATER EXTRACTION & REMEDUMTION TECHNICIAN PER HOUR om HR sms Bebe
PLASTIC BAG - USED FOR DISPOSAL OF CONTAMINATED
ITEMS. Lee une iaa8 e538
CONTENT MANIPULATION
CHARGE - PER HOUR ast ae Snes oe
ADD FOR PERSONAL PROTECTIVE EQUIPMENT. HEAVY DUTY ae te 41887 See
APPLY ANTIMICROBIAL AGENT TO (4) wha? $034 Saat
HEPA VACUUMING -LIGHT (PER SF) euntt SOF $o45 See
GENERAL CLEANUP auty $028 $H28
Tranks te maietasinvess, Subtotal: S2nreas
Totat: $2,973.15
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OWNER NAME
LEONES DESCOLLIN s
ADDRESS
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4 LO. HARNES LANE. KiS <> IMME
FLORIDA, 34743
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Preview
Filing # 135616687 E-Filed 09/29/2021 10:14:58 PM IN THE SMALL CLAIMS DIVISION OF THE Ninth JUDICIAL CIRCUIT IN AND FOR Osceola COUNTY, FLORIDA Loss Restorations LLC, Case No.: a/a/o Leones Descollines and Louise Jean Kelly, Plaintiff(s) vs. Defendant 1: Defendant 2: AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA Defendant(s) Address: Address: STATEMENT OF CLAIM Plaintiff(s) sue(s) the Defendant(s) for damages which do not exceed $8,000.00 exclusive of costs and interest for (check one category below): [4 Auto Accident occurring on or about, in the vicinity of , in, County, Florida caused by the negligent operation of a vehicle operated by _ and owned by resulting in damages, described below. ( Goods sold by Plaintiff; goods and prices and credits listed below. CO Work done and materials furnished; time and materials, showing charges and credits, listed below. [{) Money lent to defendant on with interest owed since [J Promissory Note executed on , copy attached; defendant failed to either pay the note or an installment payment, and interest is owed since , plus attorney's fees. C2 Account Stated for an agreed balance owed on business transactions between the parties, the defendant did not object to the statement of account presented, a copy of which is attached. Other claim — Please specify; Breach of Contract - Monies Owed Explain below the details (what happened, dates, times, place, etc.) of your claim. This section must be completed. Attach additional pages if needed. Please see attached Complaint Attached is a copy of any written document(s) that is that basis of this claim. WHEREFORE, the Plaintiff(s) demand judgment in the principal sum of $ [$2,973.15 Plus costs, if known, (summons, service) in the amount of $ Plus interest in the amount of $ TOTAL $ [$2,973.15 Plaintiff Address: Signature of Plaintiff(s) CJ Law Firm PA Carlos J. Camejo- 6900 Tavistock Lakes Blvd, Suite 400 Print namé of Plaintiff(s) Orlando, Florida 32827 Telephone No. Title (if applicable) Email Addresses: {@ojlawfirmpa.com IN THE COUNTY COURT IN AND FOR OSCEOLA, FLORIDA SMALL CLAIMS CASE NUMBER: LOSS RESTORATIONS LLC, a/a/o Leones Descollines and Louise Jean Kelly, Plaintiff VS. AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA, Defendant. STATEMENT OF THE CLAIMS/COMPLAINT AND DEMAND FOR. JURY TRIAL Plaintiff, LOSS RESTORATIONS LLC., a/a/o Leones Descollines and Louise Jean Kelly, by and through the undersigned counsel sues the Defendant, AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA, a Florida profit corporation, and alleges: GENERAL ALLEGATIONS 1 This is an action for damages less than eight-thousand ($8,000.00), so as to be within the jurisdictional limits of this court, but, exclusive of interest, attorney's fees, and costs. 2. Plaintiff, LOSS RESTORATIONS LLC., a/a/o Leones Descollines and Louise Jean Kelly, is a Florida Profit Corporation doing business in the county of this Court. 3 The Defendant, AMERICAN INTEGRITY INSURANCE COMPANY OF FLORIDA, is a Florida insurance company authorized to do and actually conducting insurance business in county of this Court. 4 Defendant issued an insurance policy to Leones Descollines and Louise Jean Kelly (“Insured/Assignor”), (Policy No.: AGH0076566 and Claim No.: CHO-00101198) affording residential property and casualty insurance coverage for the property located at 125 Harness Ln, Kissimmee, FL 34743. A copy of the policy is presently unavailable to the Plaintiff, but Defendant retains a copy of same. 5 Insured/Assignor paid the premium charged by Defendant for the coverages afforded pursuant to the terms of the policy, and the policy was in full force and effect on the date of loss. 6 On or about 08/18/2020, the aforementioned insured property sustained covered water damages as a result of water damage which caused substantial property damage and further insured losses. 7 Insured/Assignor submitted a timely claim to Defendant for the alleged damages and has met all conditions precedent tothe filing of a lawsuit. 8 Plaintiff brings this action as the assignee of Insured/Assignor. A copy of the assignment is attached hereto as Exhibit “A.” 9 The assignment complies with the requirements of Fla. Stat. 627.7152(2)(a) insofar as the assignment: 1 is in writing and executed by the assignor and assignee; ii. contains a provision that allows the assignor to rescind the agreement without penalty within 14 days of execution, at least 30 days after the date work is scheduledto commence if assignee has not substantially performed, or at least 30 days after execution ifthe agreement does not contain a commencement date and the assignee has not begun substantial work; iii. contains a provision requiring the assignee to provide a copy of the executed agreement to the insurer within 3 business days after the date on which the assignment is executed or the date on which work begins, whichever is earlier; iv. contains a written, itemized, per-unit cost estimate of services to be performed by the assignee; V. relates only to work to be performed by the assignee for services to protect, repair, restore, or replace a dwelling or structure or to mitigate against further damageto such property; vi. contains the following notice in 18-point uppercase and boldface type: YOU ARE AGREEING TO GIVE UP CERTAIN RIGHTS YOU HAVE UNDER YOUR INSURANCE POLICY TO A THIRD PARTY, WHICH MAY RESULT IN LITIGATION AGAINST YOUR INSURER. PLEASE READ AND UNDERSTAND THIS DOCUMENT BEFORE SIGNING IT. YOU HAVE THE RIGHT TO CANCEL THIS AGREEMENT WITHOUT PENALTY WITHIN 14 DAYS AFTER THE DATE THIS AGREEMENT IS EXECUTED, AT LEAST 30 DAYS AFTER THE DATE WORK ON THE PROPERTY IS SCHEDULED TO COMMENCE IF THE ASSIGNEE HAS NOT SUBSTANTIALLY PERFORMED, OR AT LEAST 30 DAYS AFTER THE EXECUTION OF THE AGREEMENT IF THE AGREEMENT DOES NOT CONTAIN A COMMENCEMENT DATE AND THE ASSIGNEE HAS NOT BEGUN SUBSTANTIAL WORK ON THE PROPERTY. HOWEVER, YOU ARE OBLIGATED FOR PAYMENT OF ANY CONTRACTED WORK PERFORMED BEFORE THE AGREEMENT IS RESCINDED. THIS AGREEMENT DOES NOT CHANGE YOUR OBLIGATION TO PERFORM THE DUTIES REQUIRED UNDER YOUR PROPERTY INSURANCE POLICY. vii. contains a provision requiring the assignee to indemnify and hold harmless the assignor from all liabilities, damages, losses, and costs, including, but not limited and does not contain any prohibited content. 10. Plaintiff, provided necessary, emergency services, construction services, and other compensable services for Insured/Assignor and in exchange, the Insured/Assignor agreed to allow direct billing to the insurance carrier, Defendant, and further agreed to assign all rights under the insurance policy. 11. Defendant, has not been prejudiced by any failure of Plaintiff to maintain records of all services provided under theassignment agreement, cooperate with the insurer in the claim investigation, provide the insurer with requested records and documents, or deliver a copy of the assignment agreement. 12. Plaintiff has provided the Insured/Assignor with accurate and up-to-date revised estimates of the scope of work to be performed as supplemental or additional repairs are required, performed work in accordance with industry standards, has not sought payment from the Insured/Assignor exceeding the deductible unless the Insured/Assignor has chosen to have additional as submitted to requests for examination under oath and/or recorded statements and/or participated in appraisal or other alternativedispute resolution, if requested. 13. Plaintiff submitted (a) reasonably priced bill(s) for the servicesto Defendant, for the alleged damages and has met all conditions precedent to the filing of a lawsuit. 14. Plaintiff provided the named insured, insurer, and the assignor,if not the named insured, with written notice of intent to initiate litigation before filing suit under this insurance policy. Such notice was served by certified mail, return receipt requested,or electronic delivery at least 10 business days before filing suit, but not before coverage was determined. A copy of said notice is attached hereto as Exhibit “B.” COUNT I- BREACH OF CONTRACT 15. Plaintiff adopts and incorporates! through 14. 16. Defendant has breached the insurance policy contract by refusing to pay the full amount of the invoice for Plaintiffs services. 17. Defendant has breached the insurancecontract by failing and refusing to tender all insurance proceeds due and owing to the Plaintifffor the covered losses sustained to the Insured/Assignor, and performed and/or paid for by Plaintiff. 18. Alternatively, Defendant has breached the insurance contract by issuing payment to parties other than Plaintiff to the exclusion of Plaintiff, despite the valid assignment of benefits and direction to pay. 19. As a result of Defendant, Plaintiff has been deprived of the coverages and other benefits afforded underthe insurance policy. 20. Asa direct and proximate result of Defendant's aforementioned breach of the insurance policy contract, Plaintiff has sustained damages for which Plaintiff is entitled to be indemnified against under the Policy and which were payable to or on behalf of Plaintiff Insured/Assignor in connection with the loss to Insured/Assignor property 21. Plaintiff has complied with all conditions required to be performed, and/or have been excused from performance of any conditions by the conduct of Defendant, and/or said conditions have otherwise been waived. 22. As a further result of Defendant’s breach ofcontract, Plaintiff has been forced to retain undersigned counsel for this action and it is entitled to a reasonable attorneys fees thereby pursuant Fla.Stat. 627.428 and modified by Fla. Stat. 627.7152. WHEREFORE, the Plaintiff, demands judgment against the Defendant and other relief this Court deems appropriate. DEMAND FOR JURY TRIAL 23. Plaintiff demands trial by jury of all issues that are triable as a matter of right. DESIGNATION OF E-MAIL ADDRESS PURSUANT TO RULE 2.516 Pursuant to Florida Rule of Judicial Administration 2.516, Plaintiff hereby files its notice of designation of email address for the purpose of service of all documents required to be served in this proceeding: cj@cjlawfirmpa.com. DATED this September 29, 2021. CJ LAW FIRM, P.A. Attorney for Plaintiff 2332 Galiano St., 2nd Floor Coral Gables, Florida 33134 6900 Tavistock Lakes Blvd, Suite 400 Orlando, FL 32827 Telephone: (305) 728-7049 (321) 274-1298 (Orlando) Email: cj@cjlawfirmpa.com E-Service: cj@cjlawfirmpa.com BY: /s/ CARLOS J. CAMEJO CARLOS J. CAMEJO, ESQUIRE Exhibit A om & Emergency Assignment Agreement ; |, Leones Descollines & Louise Jean Kelly the Homeownerinsured, and or its representative for the property located at 125 Harness Lane , Kissimmes, Florida, 34743, United States (hereinatter “Client’}, authorize Loss Restorations LLC (hereinafter “Service Provider’) to enter said to perform services to protect, repair. fesiore, or a ‘of structure or to miligate against further damage to such property. Client and Service Provider hereby acknowledge that the services lo be provided are being pt ovided in an urgent or emergency circumslance. Chent agree to fully cooperate with insurance company as required by the s: subject policy of ingurance and comply with alt postloss duties required by same. Client aiso accepts responsibilty to protect any equipment leftat the subject property for mitigation and remediation purposes. ; Clent hereby sssign any and all insurance rights, benefits, and proceeds under my property insurance policy up to the amount of the services provided by Service Provider. Chant also hereby instructs and directs my insurance carries to make a separate and individual payment to be sent rectly to Service Provider, ar its representatives for the services in the in the instant matter. Ckent makes this assignment anc authorization in consideration of Service Provider's agreement to perform services and supply matenals and otherwise perform its obligations under this contract, including not requiring full payment at the time of service. Chent believes the appropriate insurance carner to be American Integrity Insurance Company of Florida. Service Provicer shall provide a copy of the executed assignment agreement to the name insurer withid 2 business days alter the date on which the Assignment agreement was execul: ed or the date on which work begins, whichever is earber, Delivery of the copy of the assignment agreement to the insurershail be made by ore of the methods proscnbed in Fis. Stat. § 627.7152. Client also hereby mstructs my iesurance camer to release any and all information requested by Service Provider its representative, or its Atlomey solely for the direct purpose of cblaing actual benelts to be paid by my insurance carrier for services: fendered or to be rendered. Chent hereby assign all legal rights 16 recaver any and all insurance proceeds owed by my action up to the insurance company regarding this loss; including but not lamited fo the right to bring appropriate legal amount owed for the services rendered by Service Provider. Service Provider shall be entited to any and all recovery of costs, and attorney's fees associated with Ine collection of the: invoice from Chent’s insurance Company as provided lor under Fla, Stat. § 627.752. Chent has the right to rescind the assignment agreement without @ penalty or tee by submitting a written notice of rescission signed by Client to Service Provaier within 14 days after the execution of the ent, at least 30 days alter the date work on the px is scheduled to commence if Service Provider has not substantially performed. or al least 30 days after the execution ‘of the agreemerit # the agreement does. not contain a commencement date and the assignee has not begun substantial work on the property. Pp: sand Interest: if ior any reason payment is made to te Owner/Agent by an insurer for the services provided by Service Provider ‘under the instant contract, it shall be endorsed over to Service Provider within three (3) business days. C ent agrees that any portion of work, deductibles. betterment, depreciation of additional work requested by the undersigned. not covered by insurance, must be paid by the undersigned on or before its. completion. Clent hereby appoints Service Provide ¢ as attorney in-lact. authorizing Service Proviger to endorse Client's name, and to deposit insutance checks or cralts for Service Provider. Payment terms to Service Provider ave nel-30 days. in the event that legal or collection agency proceedings mus! 2 he instluled to recover any amount due, Service Provider shall be entitied to recover the cost of collections, incluaing. collection agencies, attorney's fee and courts, plus a linance charge of 1.5% per month to all amounts due. In exchange for this assignment of benefits Service Provider agrees to indemnity and hold harmless Client trom all liabilities, damages, losses, and costs. including, but not limited to. attorney fees, should the policy subject to the assignment agreement prohibit, in whole of in part, the assignment ‘ot benelits, ve-ma DD 8/26 /2O 5 Lin MTEL TS TELLICO TEL ELLE LEELA, eosnayae ton Capea steretampemieette & i: in the event Service Provider is not allowed to perform its recommended remediation procedures and protocols for any reason beyond its control, Client agrees to release and hold Service Provider harmiess. and indemnity Service Provider against alt claims or actions that may result from such procedures. Client has read and understand the information above and have received a copy for my records. This contract Is intended to be legally binding and contains ail of the terms and conditions between the parties. YOU ARE AGREEING TO GIVE UP CERTAIN RIGHTS YOU HAVE UNDER YOUR INSURANCE POLICY TO A THIRD PAR TY WHICH MAY RESULT IN LITIGATION AGAINST YOU A INSURER PLEASE UNDERSTAND THIS DOCUMENT BEFORE SIGNING IT. YOU HAVE THE RIGHT TO CANCEL THIS AGREEMENT WITHOUT PENALTY WITHIN 14 DAYS AFTER THE DATE THIS AGREEMENT IS EXECUTED, AT LEAST 30 DAYS AFTER THE DATE WORK ON THE PROPERTY 1S SCHEDULED TO COMMENCE IF THE ASSIGNEE HAS NOT SUBSTANTIALLY PERFORMED, OR AT LEAST 30 DAYS ER THE EXECUTION OF THE AGREEMENT IF THE AGREEMENT DOES NOT CONTAIN A COMMENCEMENT DATE AND THE ASSIGNEE HAS NOT BEGUN SUBSTANTIAL WORK ON THE PROPERTY. HOWEVER, YOU ARE OBLIGATED FOR PAYMENT OF ANY CONTRACTED WORK PERFORMED BEFORE THE AGREEMENT IS RESCINDED. THIS AGREEMENT DOES NOT CHANGE YOUR OBLIGATION TO PERFORM THE DUTIES REQUIRED UNDER YOUR PROPERTY INSURANCE POLICY. Chent Signature: Client Name: ms ec Signature: ‘Gn Behalf of: Poticy No. Loss Restorations AGHOOTESE6 | Lic Chent Signature: ‘Chaim No. CHOO0101 198 Client Name: Date: 08-26-2020 Phone: (407) 099-078 doo Site Address: 125 Harness Lane , Kissimmee, Florida, 34743, United States Date of Loss: 08-18-2020 sto oie Catch es oe Customer Equipment Responsibility Form Cilent Name: Leones Descollines & Louise Jean K: Loss Address: 125 Hamess Lane , Kissimmee, *8Y Date of Loss: 08-18-2020 Florida, 34743, United States 4 LGR Dehumiditiers sminsiotain 4 Air Scrubber 4 perenne Air Movers 4 rete ea Injection Cabinets ‘Customer has been informed of the fallowing requirements regarding equipment place on the job site. 1 be felt operating at all times. Do not move uniess you contact “LOSS RESTORATIONS LLC regarding handling procedures. Tuning of equipment will increase time required to properly dry structure and/or contents, and may cause i 2.A waterdamaged dwelling should maintain a temperature setting thal promotes ideal drying conditions. Leavis windews or doors open during dehumicification or setting alr conditioning too low may increase drying time and damage ‘Structure and/or contents, 2. Shouk! Client experience any problems with the equipment, client shail shut same off immediately and contact our office a3 soon as possible. 4. Chent is responsible for damage to, and/or joss of, this equipment while it js in Clent’s care, custody andior control, including but not limited to loss by theft. vandaksm or disappear: ANCE, 5. It is the Client's responsibility to allow access to the loss location to enable LOSS RESTORATIONS LLC to check on and pick up the equipment. 6. The above equipment may be picked up between the hours of am, and p.m. Monday through Friday excluding holidays. 7. The equipment will be connected the electrical system in the dwelling/structure, I shall be the Client's responsibility to have the electrical system inspected and serviced @ qualified elecincian if nece: ys 8. The Client agrees to hold LOSS RESTORATIONS LLC. theit respective officars, directors, employees, agents and affiiates harmless and indemnify same from any and all claims. including costs, expenses and attomey’s fees, resulting from the improper use of equipment by the Clients and/or any defects on the electrical or plumbing systems in the Clients’ dwelling/structure. Customer, Leones Descollines & Louise Jean Kelly, and provider LOSS RESTORATIONS LLC acknowledge receipt of the above documented equipment in good working order. fo oft Be peat enn ose 2020Descoltines Customer Signature: Louise Jean Kelly 08-26-2020 Customer Signature: LOSS RESTORATIONS LLC 08-26-2020 wider's Signature: te i 7 oo Certification of Satisfaction Customer: Leones Descollines& Louise Jean Kelly Insurance Company: American Integrity insurance Companyof Fionda Claim No: Oid our employees present themselves professionally? Yes No Comments: mec ere ee Did Our sub-contractors present themselves professionaily? ‘Yes, Comments: crn se Did LOSS RESTORATIONS LLC, complete the claim in a satisfactory manner? (Fes)no How do you rate LOSS RESTORATIONS LLC performance: LOSS RESTORATIONS LLC Performance Excellent The loss or damage for wich this claim has been and restored to my four) full satistaction and | (we) direct and ‘Sur insurance Company to pay LOSS RESTORATIONS LLC, directly tor service rendered, - che. wl pus ykled. Insured/Owner- 08-30-2070, insuredOwner: 08-30-2020 Leones Descolines Louise Jean Katty te CG LOSS- RESTORATIONS Estenate ate: 2020-08-26 10:40:89 Loss Restorations LLC From: Bilt To: Loss Restorations LLC ESTIMATE #: EST-000820 Leones Descollines 11018 Grande Pines Circle 125 Hamess Lane Orlando, FL, 32821 Kissimmee, Florida 34743, United States FRERGENCY SERVICE ING BUSINESS 1.00 EA $145.34 $145.34 THERMAL IMAGING SERVICE 1.00 EA $250.00 $250.00 DEHUMIDIFIER, {PER 24 HOUR PERIOD) LARGE MONITORING - NO 1 Unitls Per 4 day/s 4.00 UND $125.00 $500.00 ADD FOR DENUMIDIFIER FILTER 1.60 EA $102.35 $102.35 ee AIR FAN/AIR SCRUBBER (24 HR PERIOD) - 1 Unit/s Per 4 day/s 4.00 UND $120.00 $480.00 apo FOR HEPA FILTER (FOR NEGATIVE AIR EXHAUST 0.25 UND $185.43 $46.36 AIR MOVER (PER 24 H IOUR PERIOD) - NO MONITORING 1 Univs Per 4 day/s 4.00 UND $32.00 $128.00 WALL CAVITY DRYING. INJ. TYPE (PER 24 HR PERIOD NO MONIT. ) 4.00 UND $ 120.00 $3 480.00 1 Unit’s Per 4 day/s DRILL HOLES FOR WALL CAVITY DRYING 400 EA $0.65 32.60 EQUIPMENT DECONTAMINATION CHARGE - PER PIECE OF EQUIPMENT 4.00 UND: $42.00 $ 168.00 EQUIPMENT SETUP, TAKE DOWN, AND MONITORING {HOURLY CHARGE) 4.00 $50.85 $203.40 WATER EXTRACTION & REMEDIATION TECHNICIAN - PER HOUR 0.50 $50.88 $25.43 PLASTIC BAG - USED FOR DISPOSAL OF CONTAMINATED ITEMS 1.00 UND. $3.38 $3.38 CONTENT MANIPULATION CHARGE - PER HOUR 0.67 HR ADD FOR PERSONAL PROTECTIVE EQUIPMENT- $52.65 $35.10 HEAV' 2.00 EA $18.82 $37.64 APPLY ANTI-MICROBIAL AGENT TO {V} 651.22 SOF $0.34 $221.41 HEPA VACUUMING - LIGHT - (PER SF) 2u074 SOF $0.40 $84.68 GENERAL CLEAN UP ant SOF $0.28 $59.28 Subtotal: $2,972.97 Total: $ 2,972.97 BONES DESCOLLINES - INITIALS {Dd -pare: & |; ut/' Le LIK Length:17,17ft | Width: 12,33 ft | Height 6,92ft Scope Sheet ZONE 1 TEMP RH% TEMP RH% Wed 2020-08-26 72,9 63,8 64,7 86,5 56,6 68,9 Thur 2020-08-27 78,6 58,0 62,3 86,9 55,8 68,8 Fri 2020-08-28 78,3 56,1 61,0 87,4 55,6 69,1 Sat 2020-08-29 83,1 48,8 61,3 87,8 55,1 69,5 Sun 2020-08-30 86,9 40,5 60,2 88,0 55,1 69,8 4 a Zone 1 Equipment Placement Air mover (per 24 hour period) ~No monitoring Block and pad furniture in room = Deodorize ‘Axial fan air mover - 1 HP (per Large amount 24 hr period)-No monit. Carbon Filter Drill holes for wall cavity drying Wall cavity drying-Inj. type (per Protect - Cover with plastic st. Stage Filter 24 hr period) No monit. Ozone Machine ‘Air Mover (per 24 hour period) No monitoring - MR General Clean Up 211,71 ‘Containment trier irlock [Decon. Chamber \ehumidifier (per 24 hour period) Remove polyethylene vapor barrier ~No monitoring Remove wet caiing tiles drywall Dehumidifier (per 24 hour period) Containment Barrier - tension post- and bag Large- No monitoring per day Peel & seal zipper - heavy duty -after Tear out baseboard Dehumidifier (per 24 hour business hours period) XLarge - No Cabinet - full height unit - Detach monitoring Dehumidifier (per 24 hour period) XXLarge - No Floor 21474 Cabinet - lower (base) unit - Detach monitoring Walls 439,51 ‘Add for dehumidifier filter Ceiling Cabinet - vanity unit - Detach Dehumidifier (per 24 hour period) Thermal Fog Large- No monitoring — MR Countertop - flat laid plastic lam. - gh Detach Countertop - solid surface/granite - Refrigerator - Detach Negati air fan/Air ‘uber Detach (24 hr period) - No monit. Washing machine — Detach Interior door slab only ~ Detach ‘Add for HEPA filter or 0.25 Tear out non-salv floating floor & negativealr exhaust fan) Diver aleciio~ Dated bag Negative Arran] Ar Scrubber Tear out non-salv solid/eng. wood (24 br period) — MR Dishwasher — Detach floor & bag Ti Soubbe Aner Tear out wet drywall, no bagging ‘Internal. Range - freestanding - electric - Filter Detach IEPA fiter for TEPRVAC Tear out wet non-salvage opt, a cuvbag Plastic bag - used for isposal o Tear out wet non-salv. gluedn. cpt, Power distribution box contaminated items cut/bag HEPA Vacuuming - Light - (PER 2471 Wood floor drying extraction mat SF) Tear out non-salv. vinyl tile, cut & (per 24 br prd).No monit. Dueling « tele = 6" round. bag Water Extraction from hard surface floor Tear out and bag wet insulation Equipment decontamination Gas Power Generator (Gas charge- per piece of oa pment Included) Dry Wall Removal Bag debris for disposal pet bag vm W-9 ‘Pee, Cctober: 2018; identiNumber on Certifi ficandati cation Do net Desertsof > Goto for inetructions and the latest information. et em — RTT TRIE LOSS RESTORATIONS, LLC one of tw | 4 Exierptons only ck on fed 1. 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Luma US. otizen of cher US. ana 1 prrokcny oer wmf agate are an ACA ni Yu tt ons eu er 2 above ty have bow note by te AS een tatrou secretly atin ites pets ven cin 2 ove oot apply, For: ee of _ contibutions to an irsiardual retirement arrangemart SFA, neta ee 8, tater, Seman Sign | sare — ‘Here | US. perwnt -* Form 1009-0 General Instructions ‘Section references are t0 tw internal -# Forn 1000-086 For the atest abort dewelaonenrts: «Fonn 1090-8 ‘pplated to Form W-9 and ts inauuctions, such: Transactionsby they were gots: «Form 1008S Purpose of Form Form 1000-K ‘acho is required | Ferm 1098 iedoemation rohan with the [RS must obten your correct taxpayer 1o88-T gution) rember (TIN) weich may be your: (BBN, individual ‘identiioation marnber (ATM, (EIN. to report on an amigurt repartehie oF ORIG: Cant App j Loss Restorations 10 5 toss nestanariows INVOICE #: INV-000969 Loss Restorations LLC invnlge Dates O84 L 20ee rsa: Bai te: INVOICE esi v comme Loss Restorations LLC Leones Descoltines ChAIRs HGo0I p19 LIOLS Geanete Plage Cacte 2 vets Lae 2 2U200R 18 Retard, 82821 openmee, Flore INSURANCE COMPANY: drneric vegty, 4743 United States limaemce Company OF Ronda POLICY NUMBER: AunOoTERGG EMERGENCY SERVICE CAL . DURING BUSINESS HOURS, 100 FA $3850 THERMAL IMAGING SERVICE Lae w& $208 S20ie DEHUMIDIFIER (PER 24 HOUR PERIOD) LARGE -NO MONITORING. 460 uN YER. Syn.oG 1 Uniys Pera dag’ ADO FOR OEHUMIDIFIER FILTER La i $368.98 $10.35 NEGATIVE AIR FAN AIR SCRUBBER (74 HR PERIODS NO MONIT. he uND Sea, oe Saenne yUisaePen & aya ADO FOR HEPA FILYER (FOR NEGATIVE AIR EXHAUST FAN) ee ue $364) $5.96 AIR MOVER (PER 24 HOUR PERIOD: . NO MONITORING aay Ut S300 Soe 82 LOst/sBera days ‘WALL CAVITY DRYING-INJ. TYPE (PER 24 HR PERIOD} NO MONIT. Me Sob $4.08 Vrety ‘ePer 4 days DRILL HOLES FOR WALL CAVITY DRYING 48 fA gob EQUIPMENT DECONTAMINATION CHARGE - PER PIECE OF EQUIPMENT Amt oN baz 06 5188.00 EQUIPMENT SETUP, TAKE DOWSE, AND MONITORING (HOURLY CHARGE) aoe ate $90.85 oaonae WATER EXTRACTION & REMEDUMTION TECHNICIAN PER HOUR om HR sms Bebe PLASTIC BAG - USED FOR DISPOSAL OF CONTAMINATED ITEMS. Lee une iaa8 e538 CONTENT MANIPULATION CHARGE - PER HOUR ast ae Snes oe ADD FOR PERSONAL PROTECTIVE EQUIPMENT. HEAVY DUTY ae te 41887 See APPLY ANTIMICROBIAL AGENT TO (4) wha? $034 Saat HEPA VACUUMING -LIGHT (PER SF) euntt SOF $o45 See GENERAL CLEANUP auty $028 $H28 Tranks te maietasinvess, Subtotal: S2nreas Totat: $2,973.15 Hits: doss-cestorations comvicontrovindes php ipo 4Bié-mveioes printtid scawnOig we i “ st OWNER NAME LEONES DESCOLLIN s ADDRESS or a3 4 LO. HARNES LANE. KiS <> IMME FLORIDA, 34743 st i eh _ pe DS oy FRONT HOUSE