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Filing # 71221525 E-Filed 04/25/2018 01:22:56 PM
IN THE COUNTY COURT OF THE 17"
JUDICIAL CIRCUIT IN AND FOR
BROWARD COUNTY, FLORIDA
SOUTH FLORIDA DRY OUT SERVICES
LLC A/A/O ANNIE SAPP CASE NO.: COWE-18-000010
Plaintiff,
vs.
STATE FARM FLORIDA INSURANCE
COMPANY,
Defendant.
/
PLAINTIFF’S FIRST REQUEST FOR ADMISSIONS TO DEFENDANT
COMES NOW, the Plaintiff, SOUTH FLORIDA DRY OUT SERVICES LLC A/A/O
ANNIE SAPP (herein after “Plaintiff’), by and through the undersigned counsel, pursuant to
Florida Rule of Civil Procedure 1.370, requests that the Defendant, STATE FARM FLORIDA
INSURANCE COMPANY (“Defendant”) admit or deny the truth of the matters hereinafter set
forth, within thirty (30) days of the service of this request by answering in writing.
1. On October 7, 2016, the insured, Annie Sapp, had a property insurance policy with
Defendant in full force and effect with respect to the property at 1699 NW 7" Terrace, Pompano
Beach, FL 33060.
2. The insurance policy between Annie Sapp and the Defendant provided coverage to
the insured for damage caused to the property as a result of water damage.
3. On October 7, 2016, the insured property located at 1699 NW 7" Terrace, Pompano
Beach, FL 33060 was damaged as the result of a loss stemming from a roof leak.
4. The Defendant was timely notified of the October 7, 2016 water loss to the above
property.
*** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 4/25/2018 1:22:57 PM.****5. The Defendant acknowledged the October 7, 2016 loss, and assigned claim number
59-9M40-235 to the subject loss.
6. That the document attached as Exhibit A is the copy of Plaintiff's Assignment of
Insurance Benefits and Authorization for Direct Payment, with Defendant’s insured, Annie Sapp
for the subject claim no. 59-9M40-235.
7. The homeowner’ insured, Annie Sapp assigned its insurance benefits to the Plaintiff
through the Assignment of Benefits form.
8. The Defendant received the Assignment of Benefits form prior to the filing of this
lawsuit.
9. That Defendant received an invoice from the Plaintiff for services rendered by the
Plaintiff with respect to the subject claim no. 59-9M40-235 prior to the filing of this lawsuit.
10. That the document attached as Exhibit B is the copy of Plaintiff's invoice that
Defendant received with respect to the subject claim no. 59-9M40-235.
11. That Defendant did not issue full payment for the invoice attached as Exhibit B, for
restoration services provided by the Plaintiff, with respect to the subject claim no. 59-9M40-235.
12. That Defendant did not retain a company to conduct a peer review of Plaintiff's
Invoice, attached as Exhibit B.
13. That the items listed on Plaintiffs invoice are reasonable for the services provided
by the Defendant, with respect to the subject claim no. 59-9M40-235.
14. The Plaintiff has complied with all prerequisites to receiving benefits under the
above policy, with respect to the subject claim no. 59-9M40-235.
15. The Plaintiff has fulfilled all conditions precedent to filing the instant lawsuit.16. The Insured, Annie Sapp complied with all pot-loss obligations with respect to the
subject claim no. 59-9M40-235.
17. The Defendant failed to either issue payment or deny coverage for the subject claim
within ninety (90) days of the October 7, 2016 being reported.
18. The Defendant is in breach of the subject contract of insurance.
19. The Defendant is responsible for paying the Plaintiff's attorney’s fees and costs
pursuant to section 627.428, Florida Statutes, with respect to the subject lawsuit.
CERTIFICATE OF SERVICE
WE HEREBY CERTIFY that a true and correct copy of the foregoing was served via email
and/or e-portal on April 24, 2018, to: Attorneys for Defendant, Ilana Green Kellner, Esq.
(igreen@gaflaw.com; and eservice@gaflaw.com).
By: //Lance B. Stephan
LANCE B. STEPHAN, ESQ.
Florida Bar No: 0117972
THE MINEO SALCEDO LAW FIRM, P.A.
Attorneys for Plaintiff
5400 S. University Dr., Suite 502
Davie, FL 33328
T: (954) 463-8100
F: (954) 463-8106
mincolaw.com
neolaw.comEXHIBIT
AY \ uw
South Florida Dry Out Services LLC
6538 Collins Ave #640 Miami Beach, FL 33141
Phone: 786-486-6035 ancl 786-564-8693 Email: stlicyoul@igmatl.com
cite: Aen Sapp ___ Date: Wo| Lb
Address: ID9.4 N.w. PA a tnprance Co. GATE Eterh_roieyt WKo 6310-5
Cityrsitertip Porrpane, Pl 33260 aso ae SOT M HOD AS
hone T5Y 943 “AG laf, _ Adjuster phone
Email ‘Feetnician
‘The mpteement is made between The Cliost lished (hereinafter referred to as The Client and South Blorids Dry Out Services LLC Miereinstter
vedurved (ts és The Contractor), The Clioat bas suffered a.sudden and ut ied Toss ty due 6
‘WoterfMolt/Smoke/Fire eee 2 DOL aa
ann t
The Client herchy suthoriaes Tha Contractor to porfitrs the following sevicgs to muitignte the loss, pewtunt the freslth of the toaltiens
eaguahy mnaiaie seathee.and seneni sievatinee andor maintain a suitable tiving, condition anWor comfort level. Tho Client certifies tht
the danaged property has the appropriate insuratce coverage to cover this loss and that The Clivnt is responstise for payntent of ty deductible .
{dus upon frst visit) ax well as any charges om the final biffing Yor this servine Hot covered by The Client’ insurance poliay or not pald by The
Ee ingarance company fer aay’ ceason. LF there fs no ingurauee billing provided Phe Contractor will cotiedt ay equipment deposit fos
of, obek anrease ns 2.B6et
‘order to slart the fob,_ Houle cy cialis wet exist. ts City apres (het asbeded on afelies deesptcnt
Sits lnsoranee sompatty aw Chics Beitall,
‘Tho Client further authorizes and fustricts The Giiont's insures tampany to pay directly 16 the Contractor (orto include Tha Contractor as 2
vo-payed on the check or draft) thee amount shown ott ths final billlig. for work done by The Conteanior in comneation swith this clalm, The Cliont
slso-understands that the insurmace company is billed ne a courtesy and convenience io The Client. Should The Client's insurance Company fill
Yo honor this agreement, The Client will pay The Comtrattor any balance di. 11s understand that ‘The Client is personally responsible for aay
and all deductabte. charges, oF eusts nat covered by thels Insurance company. [lis The Client's complete smderstandiag that The Contractor is,
working for The Client and not The Clieats insurtawe company, Thoretore, it is understood teat The Client és uftinately responstbte fo the
Contractor fir payment of said services,
pot gnldiginon! ummroert,.. Shuuldsyathe
eis oe gtenul So saan! sess
‘The Client Will provide clear aed continuous aocess to job site Tor period whea work is scheduled. Client's electric and crater are to be made
avaliable for Contractors use duriny dre process of te work af no cost to The Contractor,
(No verbal arrangements wid be oonsidetud binding. this agréad! thet all matevial fumiiehed ora labor performed at the aunthortzation of therhosio-
ainier not snecitied in the estimate rast be in waiting in the foom of un additional contract and witl ho oltarged in addition to the price herein
agseed upon, Ail work provided for in the agreement applies to the instalation and placcinent ortly,
‘The Contractor will remove all eoastruction debris ftom the site nad! leave site in 2 bovom-clead couditiva followiag cumaptetion of restoration.
4 20% up ctiargs for ueompicted werk shall he charged ta The Client in the event The Contractor i¢ terminated fr uny reason. Thess fees
‘covor nestechting changes and everkiond and profil,
‘By auiborizing dls contract The Client allows the Contrattor to disinfectant, antisopticise, olcansc, decontaminale, deodorize,, fumigaty, purity,
sanitize, and sterilize any of the premises, Tho Clicot understands that il is beyond the expertise of The Contmetor to-deterayine Esomeoue is
sensitive (o theit application and vill hold The Consctor harmless tor their usc.
‘The Clicut bins soud the obove aril understands thaé this form vonstitutey 4 contzact for services performed. Should itbe wecessery to instiento
legal proceedings to enforce collection of this contractor, (he prevailing party hall be entifled ta reasonabte sitorney Foes,
ben
Clients Sighanins t0 begin
oe 8 |b.7 . 0,
South Florida Dry Out Services LLC Root
6538 Collins Ave. #640 Miami Beach FL 33141
Email: sfidryout@gmail.com Phone: 786.486.6055
ASSIGNMENT OF INSURANCE BENEFITS
Client/Insured Amit Sapp
Policy Number _7-9- Ke ) 63/0- Ss
Claim Number Gq b oo
Insurer SY TE fs a WM
Date of Loss \ 0 ~7 i Qo { b
L ASSIGNMENT OF INSURANCE BENEFITS
1, hereby, assign any and all insurance rights, benefits, proceeds and any causes of action under any
applicable insurance policies to South Florida Dry Out Services LLC (hereinafter referred to as
“Company”), for services rendered or to be rendered by Company. In this regard, | waive my privacy
rights. | make this assignment in consideration of Company’s agreement to perform services and
supply materials and otherwise perform its obligations under this contract, including not requiring
full payment at the time of service. | also hereby direct my insurance carrier(s) to release any and all
information requested by Company, its representative, and/or its Attorney for the direct purpose of
obtaining actual benefits to be paid by my insurance carrier(s) for services rendered or to be
rendered. I believe the appropriate insurance carrier to be__ GT ST FAWA
I. DIRECT PAYMENT AUTHORIZATION
I, hereby, authorize Company be given irrevocable power-of-attorney and my express permission to
endorse my name on any and all checks received from an insurance company on my behalf for
services provided by Company. I agree that any portion of work, deductibles, betterment,
depreciation or additional work requested by the undersigned, not covered by insurance, must be
paid by the undersigned on or before its completion. I also hereby authorize and unequivocally
instruct direct payment of any benefits or proceeds to Company.
DATED THIS__® DAYOF NoOv2Mpbey 2016, in Po PaBorda
1699 nw. "tot lompsne,f 3366
Address
Phonesemtlte SOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave, Suite 640
we Miami Beach FL 33141
xvas
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
Client: Annie Sapp Home: (954) 943-9966
Property; 1699 NW 7th Terrace
Pompano Beach, FL 33060
Operator Info:
Operator: COMPANY
Estimator; SFLDOS Business: (786) 486-6055
Business: 6538 Collins Ave. Suite 640
Miami Beach, FL 33141
Type of Estimate: | Water Damage
Date Entered: — 12/13/2016 Date Assigned:
Price List: NOV16
Restoration/Service/Remodel
Estimate: © ANNIE-SAPP-ROOFSOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave. Suite 640
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
ANNIE-SAPP-ROOF
ANNIE-SAPP-ROOF
DESCRIPTION QNTY REMOVE REPLACE TOTAL
1. Emergency service call - during 1.00 EA 0.00 130.45 130.45
business hours
2. Equipment setup 1.00 EA 0.00 59.00 59.00
3. Equipment monitoring 4.00 DA 0.00 65.00 260.00
4. Equipment take down 1.00 EA 0.00 59.00 59.00
5. Water Extraction & Remediation 10.00 HR 0.00 41.95 419.50
Technician - per hour
6. Cleaning & Remediation - Supervisory 1.00 EA 0.00 300.00 300.00
7, Equipment decontamination charge - per 9.00 EA 0.00 30.00 270.00
piece of equipment
8. Cleaning and Personal Protection 1.00 BA 0.00 24.99 24.99
Materials
9, Administrative service claim processing 1.00 EA 0.00 375.00 375.00
10. Debris Disposal 1.00 EA 90.00 0.00 90.00
11. Apply anti-microbial agent 200.00 SF 0.00 0.31 62.00
Total: ANNIE-SAPP-ROOF 2,049.94
Bedroom 1
DESCRIPTION QNTY REMOVE REPLACE TOTAL
12. Wall cavity drying-Inj. type 4.00 DA 0.00 160.00 640.00
13. Drill holes for wall cavity drying 3.00 EA 0.00 0.36 1.08
14, Air mover 4.00 DA 0.00 39.00 156.00
15. Dehumidifier 4,00 DA 0.00 139.00 556.00
16. General clean - up 1.00 EA 0.00 28.62 28.62
17. Content Manipulation charge 1.00 BA 0.00 30.62 30.62
Totals: Bedroom 1 1,412.32
ANNIE-SAPP-ROOF 12/13/2016 Page: 2SOUTH FLORIDA DRY OUT SERVICES LLC
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
Bedroom 2
6538 Collins Ave. Suite 640
DESCRIPTION QNTY REMOVE REPLACE TOTAL
18. Wall cavity drying-Inj. type 4.00 DA 0.00 160.00 640.00
19, Drill holes for wall cavity drying 4.00 EA 0.00 0.36 1.44
20. Air mover 4.00 DA 0.00 39.00 156.00
21. Dehumidifier 4.00 DA 0.00 139.00. 556.00
22. General clean - up 1.00 EA 0.00 28.62 28.62
23. Content Manipulation charge 1.00 EA 0.00 30.62 30.62
Totals: Bedroom 2 1,412.68
Hallway
DESCRIPTION QNTY REMOVE REPLACE TOTAL
24, Wall cavity drying-Inj. type 4.00 DA 0.00 160.00 640.00
25. Drill holes for wall cavity drying 4.00 EA 0.00 0.36 1.44
26. Neg. air fan/Air scrub 4.00 DA 0.00 130.00 520.00
27. Add for HEPA filter (for negative air 1.00 EA 0.00 159.15 159.15
exhaust fan)
28. Power distribution box 4.00 DA 0.00 45.00 180.00
29. Air mover 4,00 DA 0.00 39.00 156.00
30. Content Manipulation charge 1.00 EA 0.00 30.62 30.62
31. General clean - up 1.00 EA 0.00 28.62 28.62
ANNIE-SAPP-ROOF 12/13/2016 Page: 3SOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave. Suite 640
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
CONTINUED - Hallway
DESCRIPTION QNTY REMOVE REPLACE TOTAL
Totals: Hallway 1,715.83
Roof
DESCRIPTION QNTY REMOVE REPLACE TOTAL
32. Tarp - all purpose poly - per sq ft 2,400.00 SF 0.00 0.61 1,464.00
(labor and material)
Totals: Roof 1,464.00
Line Item Subtotals: ANNIE-SAPP-ROOF 8,054.77
Adjustments for Base Service Charges Adjustment
Cleaning Remediation Technician 62.60
Roofer 167.67
Total Adjustments for Base Service Charges: 230,27
Line Item Totals: ANNIE-SAPP-ROOF 8,285.04
ANNIE-SAPP-ROOF 12/13/2016 Page: 4SOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave. Suite 640
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
Grand Total Areas:
0.00 SF Walls 0.00 SF Ceiling 0.00 SF Walls and Ceiling
0.00 SF Floor 0.00 SY Flooring 0.00 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 0.00 LF Ceil. Perimeter
0.00 Floor Area 0.00 Total Area 0.00 Interior Wall Area
0.00 Exterior Wall Area 0.00 Exterior Perimeter of
Walls
0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length
0.00 Total Ridge Length 0.00 Total Hip Length
ANNIE-SAPP-ROOF 12/13/2016
Page: 5SOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave. Suite 640
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
Summary
Line Item Total 8,054.77
Total Adjustments for Base Service Charges 230.27
Material Sales Tax @ 6.000% x 484.34 29.06
Replacement Cost Value $8,314.10
Net Claim $8,314.10
SFLDOS
ANNIE-SAPP-ROOF 12/13/2016 Page: 6SOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave. Suite 640
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
Recap by Room
Estimate: ANNIE-SAPP-ROOF 2,049.94 24.74%
Bedroom 1 1,412.32 17.05%
Bedroom 2 1,412.68 17.05%
Hallway 1,715.83 20.71%
Roof 1,464.00 17.67%
Subtotal of Areas 8,054.77 97.22%
Base Service Charges 230.27 2.78%
Total 8,285.04 100.00%
ANNIE-SAPP-ROOF 12/13/2016 Page: 7SOUTH FLORIDA DRY OUT SERVICES LLC
6538 Collins Ave. Suite 640
Miami Beach FL 33141
EIN # 47-2109512
Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM
Recap by Category
Items Total Dollars %
CLEANING 85.86 1.03%
CONTENT MANIPULATION 91.86 1.10%
GENERAL DEMOLITION 90.00 1.08%
LABOR ONLY 375.00 4.51%
TEMPORARY REPAIRS 1,464.00 17.61%
WATER EXTRACTION & REMEDIATION 5,948.05 11.54%
Subtotal 8,054.77 96.88%
Base Service Charges 230.27 2.77%
Material Sales Tax @ 6.000% 29.06 0.35%
Total 8,314.10 100.00%
ANNIE-SAPP-ROOF 12/13/2016 Page: 8
Preview
Filing # 71221525 E-Filed 04/25/2018 01:22:56 PM IN THE COUNTY COURT OF THE 17" JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA SOUTH FLORIDA DRY OUT SERVICES LLC A/A/O ANNIE SAPP CASE NO.: COWE-18-000010 Plaintiff, vs. STATE FARM FLORIDA INSURANCE COMPANY, Defendant. / PLAINTIFF’S FIRST REQUEST FOR ADMISSIONS TO DEFENDANT COMES NOW, the Plaintiff, SOUTH FLORIDA DRY OUT SERVICES LLC A/A/O ANNIE SAPP (herein after “Plaintiff’), by and through the undersigned counsel, pursuant to Florida Rule of Civil Procedure 1.370, requests that the Defendant, STATE FARM FLORIDA INSURANCE COMPANY (“Defendant”) admit or deny the truth of the matters hereinafter set forth, within thirty (30) days of the service of this request by answering in writing. 1. On October 7, 2016, the insured, Annie Sapp, had a property insurance policy with Defendant in full force and effect with respect to the property at 1699 NW 7" Terrace, Pompano Beach, FL 33060. 2. The insurance policy between Annie Sapp and the Defendant provided coverage to the insured for damage caused to the property as a result of water damage. 3. On October 7, 2016, the insured property located at 1699 NW 7" Terrace, Pompano Beach, FL 33060 was damaged as the result of a loss stemming from a roof leak. 4. The Defendant was timely notified of the October 7, 2016 water loss to the above property. *** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 4/25/2018 1:22:57 PM.****5. The Defendant acknowledged the October 7, 2016 loss, and assigned claim number 59-9M40-235 to the subject loss. 6. That the document attached as Exhibit A is the copy of Plaintiff's Assignment of Insurance Benefits and Authorization for Direct Payment, with Defendant’s insured, Annie Sapp for the subject claim no. 59-9M40-235. 7. The homeowner’ insured, Annie Sapp assigned its insurance benefits to the Plaintiff through the Assignment of Benefits form. 8. The Defendant received the Assignment of Benefits form prior to the filing of this lawsuit. 9. That Defendant received an invoice from the Plaintiff for services rendered by the Plaintiff with respect to the subject claim no. 59-9M40-235 prior to the filing of this lawsuit. 10. That the document attached as Exhibit B is the copy of Plaintiff's invoice that Defendant received with respect to the subject claim no. 59-9M40-235. 11. That Defendant did not issue full payment for the invoice attached as Exhibit B, for restoration services provided by the Plaintiff, with respect to the subject claim no. 59-9M40-235. 12. That Defendant did not retain a company to conduct a peer review of Plaintiff's Invoice, attached as Exhibit B. 13. That the items listed on Plaintiffs invoice are reasonable for the services provided by the Defendant, with respect to the subject claim no. 59-9M40-235. 14. The Plaintiff has complied with all prerequisites to receiving benefits under the above policy, with respect to the subject claim no. 59-9M40-235. 15. The Plaintiff has fulfilled all conditions precedent to filing the instant lawsuit.16. The Insured, Annie Sapp complied with all pot-loss obligations with respect to the subject claim no. 59-9M40-235. 17. The Defendant failed to either issue payment or deny coverage for the subject claim within ninety (90) days of the October 7, 2016 being reported. 18. The Defendant is in breach of the subject contract of insurance. 19. The Defendant is responsible for paying the Plaintiff's attorney’s fees and costs pursuant to section 627.428, Florida Statutes, with respect to the subject lawsuit. CERTIFICATE OF SERVICE WE HEREBY CERTIFY that a true and correct copy of the foregoing was served via email and/or e-portal on April 24, 2018, to: Attorneys for Defendant, Ilana Green Kellner, Esq. (igreen@gaflaw.com; and eservice@gaflaw.com). By: //Lance B. Stephan LANCE B. STEPHAN, ESQ. Florida Bar No: 0117972 THE MINEO SALCEDO LAW FIRM, P.A. Attorneys for Plaintiff 5400 S. University Dr., Suite 502 Davie, FL 33328 T: (954) 463-8100 F: (954) 463-8106 mincolaw.com neolaw.comEXHIBIT AY \ uw South Florida Dry Out Services LLC 6538 Collins Ave #640 Miami Beach, FL 33141 Phone: 786-486-6035 ancl 786-564-8693 Email: stlicyoul@igmatl.com cite: Aen Sapp ___ Date: Wo| Lb Address: ID9.4 N.w. PA a tnprance Co. GATE Eterh_roieyt WKo 6310-5 Cityrsitertip Porrpane, Pl 33260 aso ae SOT M HOD AS hone T5Y 943 “AG laf, _ Adjuster phone Email ‘Feetnician ‘The mpteement is made between The Cliost lished (hereinafter referred to as The Client and South Blorids Dry Out Services LLC Miereinstter vedurved (ts és The Contractor), The Clioat bas suffered a.sudden and ut ied Toss ty due 6 ‘WoterfMolt/Smoke/Fire eee 2 DOL aa ann t The Client herchy suthoriaes Tha Contractor to porfitrs the following sevicgs to muitignte the loss, pewtunt the freslth of the toaltiens eaguahy mnaiaie seathee.and seneni sievatinee andor maintain a suitable tiving, condition anWor comfort level. Tho Client certifies tht the danaged property has the appropriate insuratce coverage to cover this loss and that The Clivnt is responstise for payntent of ty deductible . {dus upon frst visit) ax well as any charges om the final biffing Yor this servine Hot covered by The Client’ insurance poliay or not pald by The Ee ingarance company fer aay’ ceason. LF there fs no ingurauee billing provided Phe Contractor will cotiedt ay equipment deposit fos of, obek anrease ns 2.B6et ‘order to slart the fob,_ Houle cy cialis wet exist. ts City apres (het asbeded on afelies deesptcnt Sits lnsoranee sompatty aw Chics Beitall, ‘Tho Client further authorizes and fustricts The Giiont's insures tampany to pay directly 16 the Contractor (orto include Tha Contractor as 2 vo-payed on the check or draft) thee amount shown ott ths final billlig. for work done by The Conteanior in comneation swith this clalm, The Cliont slso-understands that the insurmace company is billed ne a courtesy and convenience io The Client. Should The Client's insurance Company fill Yo honor this agreement, The Client will pay The Comtrattor any balance di. 11s understand that ‘The Client is personally responsible for aay and all deductabte. charges, oF eusts nat covered by thels Insurance company. [lis The Client's complete smderstandiag that The Contractor is, working for The Client and not The Clieats insurtawe company, Thoretore, it is understood teat The Client és uftinately responstbte fo the Contractor fir payment of said services, pot gnldiginon! ummroert,.. Shuuldsyathe eis oe gtenul So saan! sess ‘The Client Will provide clear aed continuous aocess to job site Tor period whea work is scheduled. Client's electric and crater are to be made avaliable for Contractors use duriny dre process of te work af no cost to The Contractor, (No verbal arrangements wid be oonsidetud binding. this agréad! thet all matevial fumiiehed ora labor performed at the aunthortzation of therhosio- ainier not snecitied in the estimate rast be in waiting in the foom of un additional contract and witl ho oltarged in addition to the price herein agseed upon, Ail work provided for in the agreement applies to the instalation and placcinent ortly, ‘The Contractor will remove all eoastruction debris ftom the site nad! leave site in 2 bovom-clead couditiva followiag cumaptetion of restoration. 4 20% up ctiargs for ueompicted werk shall he charged ta The Client in the event The Contractor i¢ terminated fr uny reason. Thess fees ‘covor nestechting changes and everkiond and profil, ‘By auiborizing dls contract The Client allows the Contrattor to disinfectant, antisopticise, olcansc, decontaminale, deodorize,, fumigaty, purity, sanitize, and sterilize any of the premises, Tho Clicot understands that il is beyond the expertise of The Contmetor to-deterayine Esomeoue is sensitive (o theit application and vill hold The Consctor harmless tor their usc. ‘The Clicut bins soud the obove aril understands thaé this form vonstitutey 4 contzact for services performed. Should itbe wecessery to instiento legal proceedings to enforce collection of this contractor, (he prevailing party hall be entifled ta reasonabte sitorney Foes, ben Clients Sighanins t0 begin oe 8 |b.7 . 0, South Florida Dry Out Services LLC Root 6538 Collins Ave. #640 Miami Beach FL 33141 Email: sfidryout@gmail.com Phone: 786.486.6055 ASSIGNMENT OF INSURANCE BENEFITS Client/Insured Amit Sapp Policy Number _7-9- Ke ) 63/0- Ss Claim Number Gq b oo Insurer SY TE fs a WM Date of Loss \ 0 ~7 i Qo { b L ASSIGNMENT OF INSURANCE BENEFITS 1, hereby, assign any and all insurance rights, benefits, proceeds and any causes of action under any applicable insurance policies to South Florida Dry Out Services LLC (hereinafter referred to as “Company”), for services rendered or to be rendered by Company. In this regard, | waive my privacy rights. | make this assignment in consideration of Company’s agreement to perform services and supply materials and otherwise perform its obligations under this contract, including not requiring full payment at the time of service. | also hereby direct my insurance carrier(s) to release any and all information requested by Company, its representative, and/or its Attorney for the direct purpose of obtaining actual benefits to be paid by my insurance carrier(s) for services rendered or to be rendered. I believe the appropriate insurance carrier to be__ GT ST FAWA I. DIRECT PAYMENT AUTHORIZATION I, hereby, authorize Company be given irrevocable power-of-attorney and my express permission to endorse my name on any and all checks received from an insurance company on my behalf for services provided by Company. I agree that any portion of work, deductibles, betterment, depreciation or additional work requested by the undersigned, not covered by insurance, must be paid by the undersigned on or before its completion. I also hereby authorize and unequivocally instruct direct payment of any benefits or proceeds to Company. DATED THIS__® DAYOF NoOv2Mpbey 2016, in Po PaBorda 1699 nw. "tot lompsne,f 3366 Address Phonesemtlte SOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave, Suite 640 we Miami Beach FL 33141 xvas EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM Client: Annie Sapp Home: (954) 943-9966 Property; 1699 NW 7th Terrace Pompano Beach, FL 33060 Operator Info: Operator: COMPANY Estimator; SFLDOS Business: (786) 486-6055 Business: 6538 Collins Ave. Suite 640 Miami Beach, FL 33141 Type of Estimate: | Water Damage Date Entered: — 12/13/2016 Date Assigned: Price List: NOV16 Restoration/Service/Remodel Estimate: © ANNIE-SAPP-ROOFSOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave. Suite 640 Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM ANNIE-SAPP-ROOF ANNIE-SAPP-ROOF DESCRIPTION QNTY REMOVE REPLACE TOTAL 1. Emergency service call - during 1.00 EA 0.00 130.45 130.45 business hours 2. Equipment setup 1.00 EA 0.00 59.00 59.00 3. Equipment monitoring 4.00 DA 0.00 65.00 260.00 4. Equipment take down 1.00 EA 0.00 59.00 59.00 5. Water Extraction & Remediation 10.00 HR 0.00 41.95 419.50 Technician - per hour 6. Cleaning & Remediation - Supervisory 1.00 EA 0.00 300.00 300.00 7, Equipment decontamination charge - per 9.00 EA 0.00 30.00 270.00 piece of equipment 8. Cleaning and Personal Protection 1.00 BA 0.00 24.99 24.99 Materials 9, Administrative service claim processing 1.00 EA 0.00 375.00 375.00 10. Debris Disposal 1.00 EA 90.00 0.00 90.00 11. Apply anti-microbial agent 200.00 SF 0.00 0.31 62.00 Total: ANNIE-SAPP-ROOF 2,049.94 Bedroom 1 DESCRIPTION QNTY REMOVE REPLACE TOTAL 12. Wall cavity drying-Inj. type 4.00 DA 0.00 160.00 640.00 13. Drill holes for wall cavity drying 3.00 EA 0.00 0.36 1.08 14, Air mover 4.00 DA 0.00 39.00 156.00 15. Dehumidifier 4,00 DA 0.00 139.00 556.00 16. General clean - up 1.00 EA 0.00 28.62 28.62 17. Content Manipulation charge 1.00 BA 0.00 30.62 30.62 Totals: Bedroom 1 1,412.32 ANNIE-SAPP-ROOF 12/13/2016 Page: 2SOUTH FLORIDA DRY OUT SERVICES LLC Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM Bedroom 2 6538 Collins Ave. Suite 640 DESCRIPTION QNTY REMOVE REPLACE TOTAL 18. Wall cavity drying-Inj. type 4.00 DA 0.00 160.00 640.00 19, Drill holes for wall cavity drying 4.00 EA 0.00 0.36 1.44 20. Air mover 4.00 DA 0.00 39.00 156.00 21. Dehumidifier 4.00 DA 0.00 139.00. 556.00 22. General clean - up 1.00 EA 0.00 28.62 28.62 23. Content Manipulation charge 1.00 EA 0.00 30.62 30.62 Totals: Bedroom 2 1,412.68 Hallway DESCRIPTION QNTY REMOVE REPLACE TOTAL 24, Wall cavity drying-Inj. type 4.00 DA 0.00 160.00 640.00 25. Drill holes for wall cavity drying 4.00 EA 0.00 0.36 1.44 26. Neg. air fan/Air scrub 4.00 DA 0.00 130.00 520.00 27. Add for HEPA filter (for negative air 1.00 EA 0.00 159.15 159.15 exhaust fan) 28. Power distribution box 4.00 DA 0.00 45.00 180.00 29. Air mover 4,00 DA 0.00 39.00 156.00 30. Content Manipulation charge 1.00 EA 0.00 30.62 30.62 31. General clean - up 1.00 EA 0.00 28.62 28.62 ANNIE-SAPP-ROOF 12/13/2016 Page: 3SOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave. Suite 640 Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM CONTINUED - Hallway DESCRIPTION QNTY REMOVE REPLACE TOTAL Totals: Hallway 1,715.83 Roof DESCRIPTION QNTY REMOVE REPLACE TOTAL 32. Tarp - all purpose poly - per sq ft 2,400.00 SF 0.00 0.61 1,464.00 (labor and material) Totals: Roof 1,464.00 Line Item Subtotals: ANNIE-SAPP-ROOF 8,054.77 Adjustments for Base Service Charges Adjustment Cleaning Remediation Technician 62.60 Roofer 167.67 Total Adjustments for Base Service Charges: 230,27 Line Item Totals: ANNIE-SAPP-ROOF 8,285.04 ANNIE-SAPP-ROOF 12/13/2016 Page: 4SOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave. Suite 640 Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM Grand Total Areas: 0.00 SF Walls 0.00 SF Ceiling 0.00 SF Walls and Ceiling 0.00 SF Floor 0.00 SY Flooring 0.00 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 0.00 LF Ceil. Perimeter 0.00 Floor Area 0.00 Total Area 0.00 Interior Wall Area 0.00 Exterior Wall Area 0.00 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length ANNIE-SAPP-ROOF 12/13/2016 Page: 5SOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave. Suite 640 Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM Summary Line Item Total 8,054.77 Total Adjustments for Base Service Charges 230.27 Material Sales Tax @ 6.000% x 484.34 29.06 Replacement Cost Value $8,314.10 Net Claim $8,314.10 SFLDOS ANNIE-SAPP-ROOF 12/13/2016 Page: 6SOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave. Suite 640 Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM Recap by Room Estimate: ANNIE-SAPP-ROOF 2,049.94 24.74% Bedroom 1 1,412.32 17.05% Bedroom 2 1,412.68 17.05% Hallway 1,715.83 20.71% Roof 1,464.00 17.67% Subtotal of Areas 8,054.77 97.22% Base Service Charges 230.27 2.78% Total 8,285.04 100.00% ANNIE-SAPP-ROOF 12/13/2016 Page: 7SOUTH FLORIDA DRY OUT SERVICES LLC 6538 Collins Ave. Suite 640 Miami Beach FL 33141 EIN # 47-2109512 Phone # 786-486-6055 or 786-564-8893 SFLDRYOUT@GMAIL.COM Recap by Category Items Total Dollars % CLEANING 85.86 1.03% CONTENT MANIPULATION 91.86 1.10% GENERAL DEMOLITION 90.00 1.08% LABOR ONLY 375.00 4.51% TEMPORARY REPAIRS 1,464.00 17.61% WATER EXTRACTION & REMEDIATION 5,948.05 11.54% Subtotal 8,054.77 96.88% Base Service Charges 230.27 2.77% Material Sales Tax @ 6.000% 29.06 0.35% Total 8,314.10 100.00% ANNIE-SAPP-ROOF 12/13/2016 Page: 8