Preview
Case Number: COCE-18-000365 Division: 53
Filing # 66106213 E-Filed 01/04/2018 02:15:27 PM
IN THE COUNTY COURT
IN AND FOR BROWARD COUNTY, FLORIDA
Civil Division
Case Number:
1ST STEP RESTORATION, LLC
A/A/O MOYA, JOSE & ANA
Plaintiff,
v.
GEOVERA SPECIALTY INSURANCE
COMPANY,
Defendant.
/
COMPLAINT FOR BREACH OF CONTRACT
COMES NOW, Plaintiff, Ist Step Restoration, LLC A/AO MOYA, JOSE & ANA, by
and through undersigned counsel, files this Complaint for Breach of Contract and in support
thereof states:
1. This is an action for Breach of Contract involving Damages which do not exceed
$15,000.00, exclusive of attorney’s fees and costs wherefore this Court has
subject matter jurisdiction over this matter.
2. Plaintiff is a corporation licensed to do business in the State of Florida and
conducts regular business activities in BROWARD County, Florida.
3. Defendant is a corporation licensed to do business in the State of Florida and
conducts regular business activities in BROWARD County, Florida.
4. Venue is proper in this action as the loss which forms the underlying factual basis
of this action occurred in BROWARD County, Florida.
*4* FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 1/4/2018 2:15:25 PM.****10.
ll.
12.
At all times material hereto, the Defendant provided insurance coverage to the
Assignor’s property located 4014 Johnson Street; Hollywood, FL 33021
(hereinafter referred to as “subject property”)
The insurance coverage provided by the Defendant to subject property afforded
various types of coverages including coverage for damage due to water loss and
mold.
Plaintiff is not in possession of said policy of insurance, but Defendant has
complete access to said policy.
On or about 7/20/2017, the subject property was damaged as a result of water loss
and mold.
Plaintiff and/or Assignor have furnished Defendant with timely notice of the loss,
proof of claim and have otherwise performed all conditions precedent to recover
under the policy and under the applicable Florida Statutes, but the Defendant has
refused and continues to refuse to pay either part or all of the Plaintiff’s claims.
Upon notice of the covered loss, the Defendant assigned a claim number, to wit:
HL17500704.
Plaintiff provided mold remediation services to Assignor for the damages caused
by water loss to the subject property.
Assignor equitably assigned to Plaintiff and/or executed a written assignment of
benefits, assigning to Plaintiff certain benefits payable pursuant to the policy of
insurance issued by Defendant. A copy of said assignment is attached as Exhibit
“AD13.
14.
15.
16.
17.
18.
Pursuant to said Assignment, Plaintiff submitted its bill to Defendant. A copy of
the invoice is attached as Exhibit “B”.
Defendant is in breach of its contract with its insured as it has failed to pay
Plaintiff's claim in full.
Plaintiff has been damaged by Defendant’s breach of said contract by not being
compensated in full for the repairs to the subject property.
Defendant owes Plaintiff 1st Step Restoration, LLC for the balance of the money
due for repairs to the subject property.
As a direct and proximate result of Defendant’s refusal to pay Plaintiffs claim,
Plaintiff has been required to retain the services of the undersigned attorneys to
represent and protect Plaintiffs interests and Plaintiff has become obliged to pay
them a reasonable fee for their services in bringing this action.
In the event that Plaintiff prevails in this action, Plaintiff is entitled to an award of
attorney’s fees and costs pursuant to Section 627.428, Florida Statutes as well as
interest pursuant to F.S. s. 627.70131.
WHEREFORE, Plaintiff demands judgment against the Defendant for damages
including but not limited to: Reimbursement for its water restoration services provided to the
subject property; interest as allowed by law; reasonable attorney’s fees and costs pursuant to
Section 627.428 and 57.041, Florida Statutes; trial by jury of all issues triable as a matter of right
by jury; any other relief this Court deems just and appropriate.
FLORIDA ADVOCATES
Attorneys for Plaintiff
45 Hast Sheridan Street
Dania Beach, Florida 33004
Ph: (754) 263-4252
Designated: eservice@fladvocates.comBy:__/s/ Russel Lazega
Florida Bar No.: 091588EXHIBIT “A”1st Step Restoration LLC
Phone: (954) 323-2031 - Fax: (954) 892-6880 Toll Free: 1-866-859-3217
5815 SW 21 St. West Park, FL 33023 © www.1stStepRestoration.com
CONTRACT FOR SERVICES, ASSIGNMENT OF BENEFITS, DIRECT PAYMENT AUTHORIZATION, AND
HOLD HARMLESS AGREEMENT
I, the Owner/Agent for the job site listed below, authorize (1st Step Restoration) (hereinafter referred to as “Company”) to
enter my property, furnish materials, supply all equipment and perform all labor necessary to preserve and protect my
property from further damage.
ASSIGNMENT OF INSURANCE B ITS
I, hereby, assign any and all insurance rights, benefits, proceeds and any causes of action under any applicable insurance
policies to Company, for services rendered or to be rendered by Company. In this regard, I waive my privacy rights. I 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. I also hereby direct my
insurance carrier(s) to release any and all information requested by Company, its representative, and/or it’s Attorney for the
direct purpose of obtaining actual benefits to be paid for services rendered or to be rendéfed. 1
believe the appropriate insurance catrier to be (__ Cte Ly Seni LL
DIRECT PAYMENT AUTHORIZATION
Lalso hereby authorize and unequivocally instruct direct payment of any benefits or proceeds to Company. It is very difficult
to determine the cost of the restoration until after it has been completed. The final billing will be forwarded to your insurance
company for payment. I also 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. Any checks I receive for services by the insurance company will be endorsed and send to the company for their
services. | 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
AUTHORIZED AN TS
iCROBIAL AG!
I understand that in the best judgment of Company, materials may be treated with a Commercial antimicrobial agent to
inhibit the growth of micro-organisms during the drying process. I have received advanced notice of the use of antimicrobial
and/or antimicrobial product as part of the restoration process. I understand it is beyond the expertise of Company to
determine if someone is sensitive to its application and will hold Company harmless for its use.
STOP WORK-HOLD HARMLESS
In the event Company is not allowed to perform its recommended procedures and/or drying equipment is removed
prematurely, I agree to release and hold Company harmless, and indemnify Company against all claims or actions that may
result from such procedures. I understand that I am not responsible for any damages to appliances, furniture, structure, and
future damages during remediation process.
Policy #24 HORE,
Address: 0%
Print Name Owner/Agent: La ee. Ae ye Signature Owner/A gente OS Pes
Date: DLS J?
Thave read and understand the information above and have received a copy for my records.1st Step Restoration LLC
Phone: (954) 323-2031 - Fax: (954) 892-6880 Toll Free: 1-866-859-3217
5815 SW 21 St. West Park, FL 33023 * www.!stStepRestoration.com
ASSIGNMENT OF INSURANCE BENEFITS
Client/Insured :
Policy Number. CE EéE Lb E Lil S
Claim Number HEA TS CO “1O4
= api Of ~ G Je
Insurer EE CHLSAL x. De (7, ole oy (oxPiliieitiee 6
Date of Loss T20|i9
L ASSIGNMENT OF INSURANCE BENEFITS
I, hereby, assign any and all insurance rights, benefits, proceeds and any causes of action under any
applicable insurance policies to (_1st Step Restoration LLC _)(hercinafter referred to as “Company”,
for services rendered or to be rendered by Company. In this regard, | waive my privacy rights. I
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. I also hereby direct my insurance carrier(s) to release any and all
information requested by Company, its representative, and/orits Attorney for the direct purpose of
obtaining actual benefits to be paid by my insurance carrier(s) for services aia to be
rendered. I believe the appropriate insurance carrier to b PON ALE (YE
II. DIRECT PAYMENT AUTHORIZATION -
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 DAY OF 520/%in ; Florida
IOS fo
(Print Name)Owner/Agent
7 Ee
ignature) Owner/AgentEXHIBIT “B”Ist Step Restoration
5813 SW 21st
West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
Insured: Jose Moya
Property: 4014 Johnson St
Hollywood, FL 33021
Claim Rep.: 1st Step Restoration
Company: 1 St Step Restoration
Business: 5813 S.W. 21 Street
West Park, FL 33023
Estimator: Ist Step Restoration
Company: | St Step Restoration
Business: 5813 S.W. 21 Street
West Park, FL 33023
Claim Number: HL17500704 Policy Number: GH40028105
Date of Loss: 20/2017 Date Received:
Date Inspected:
Price List:
Estimate:
Date Entered:
FLFL8X_SEP17
Restoration/Service/Remodel
2017-09-28-1500
Home: (954) 684-6063
Business: (954) 323-2031
E-mail: —1ststeprestoration@gmail.com
Business: (954) 323-2031
E-mail: _ 1 ststeprestoration@gmail.
com
Type of Loss: Mold
9/28/2017 3:00 PMIst Step Restoration
5813 SW 21st
‘West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
2017-09-28-1500
General
DESCRIPTION QTY REMOVE REPLACE T.
TOTAL
1. Iniital Inspection 1.00 EA 0.00 240.00 0.00 240.00
To determine the cause of loss and moisture detection by certified tech. To identify the water intrusion and the amount of damage by tech. To
identify safety hazard for health and potential risk. To discuss the drying process.
3. Emergency service call - during 1.00 EA 0.00 160.00 0.00 160.00
business hours
4. Equipment setup, take down, and 6.00 HR 0.00 45.06 0.00 270.36
monitoring (hourly charge)
5. General clean - up 4.00 HR 0.00 31.13 0.00 124.52
7. Supervisory - per hr 4.00 HR 0.00 47.99 0.00 191.96
8. Equipment cleaning charge - per 5.00 EA 0.00 3131 1.22 157.77
piece of equipment
9. Xactimate Specialist 1.00 EA 0.00 375.00 0.00 375.00
10. Mortgage Processing Fee 1.00 EA 0.00 500.00, 0.00 500.00,
Fee is for the time and expense to obtain the payment endorsement from the mortgage company.
20. Boots - waterproof latex - 20.00 EA 0.00 6.45 7.74 136.74
Disposable (per pair)
21. Add for personal protective 20.00 EA 0.00 18.42 22.09 390.49
equipment - Heavy duty
22. Respirator - Full face - multi- 20.00 DA 0.00 7.61 0.00 152.20
purpose resp. (per day)
3 techs
23. Respirator cartridge - HEPA only 12.00 EA 0.00 8.87 6.39 112.83
(per pair)
25. Plastic bag - used for disposal of 6.00 EA 0.00 3.38 1.22 21.50
contaminated items
Totals: General 38.66 2,833.37
Garage-AC
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
11. Containment 180.00 SF 0.00 0.63 0.76 114.16
Barrier/Airlock/Decon. Chamber
12. Content Manipulation charge - per 2.00 HR 0.00 30.50 0.00 61.00
hour
14. Clean the surface area - Heavy- 144.00 SF 0.00 0.32 0.09 46.17
Wall-Ceiling
15. Clean floor 36.00 SF 0.00 0.29 0.00 10.44
2017-09-28-1500 9/28/2017 Page: 2Ist Step Restoration
5813 SW 21st
‘West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
CONTINUED - Garage-AC
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
17. Apply anti-microbial agent to the 180.00 SF 0.00 0.20 0.32 36.32
surface area
18. Negative air fan/Air scrubber (24 5.00 DA 0.00 145.00 0.00 725.00
hr period) - No monit.
19. Add for HEPA filter (for negative 1.00 EA 0.00 184.25 10.50 194.75
air exhaust fan)
24. Remove wet ceiling tile & drywall 15.00 SF 1.33 0.00 0.12 20.07
and bag
28. Peel & seal zipper - heavy duty 1.00 EA 0.00 13.26 0.63 13.89
46. Containment Barrier - tension post - 10.00 DA 0.00 3.30 0.00 33.00
per day
2 post for 5 days
Totals: Garage-AC 12.42 1,254.80
Guest Bathroom
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
26. Containment 384.00 SF 0.00 0.63 1.61 243.53
Barrier/Airlock/Decon. Chamber
27. Peel & seal zipper - heavy duty 1.00 EA 0.00 13.26 0.63 13.89
29, Remove wet ceiling tile & drywall 48.00 SF 1,33 0.00 0.37 64.21
and bag -
31. Clean floor 48.00 SF 0.00 0.29 0.00 13.92
32. Apply anti-microbial agent to the 384.00 SF 0.00 0.20 0.69 77.49
surface area
33. Negative air fan/Air scrubber (24 5.00 DA 0.00 145.00 0.00 725.00
hr period) - No monit.
34. Add for dehum filter 1.00 EA 0.00 27.86 10.50 38.36
Totals: Guest Bathroom. 13.80 1,176.40
Living Room
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
35. Negative air fan/Air scrubber (24 10.00 DA 0.00 145.00 0.00 1,450.00
hr period) - No monit.
2 airscrubbers for 5 days
36. Add for HEPA filter (for negative 2.00 EA 0.00 184.25 21.00 389.50
air exhaust fan)
2017-09-28-1500 9/28/2017 Page: 3Ist Step Restoration
5813 SW 21st
‘West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
CONTINUED - Living Room
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
Totals: Living Room 21.00 1,839.50
Masterbath
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
37. Containment 384.00 SF 0.00 0.63 1.61 243.53
Barriet/Airlock/Decon. Chamber
38. Peel & seal zipper - heavy duty 1.00 EA 0.00 13.26 0.63 13.89
39. Remove wet ceiling tile & drywall 30.00 SF 1.33 0.00 0.23 40.13
and bag
40. Clean floor 32.00 SF 0.00 0.29 0.00 9.28
41. Apply anti-microbial agent to the 212.00 SF 0.00 0.20 0.38 42.78
surface area
42. Negative air fan/Air scrubber (24 5.00 DA 0.00 145.00 0.00 725.00
hr period) - No monit.
43. Add for HEPA filter (for negative 1.00 EA 0.00 184.25 10.50 194.75
air exhaust fan)
Totals: Masterbath 13.35 1,269.36
Ktichen
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
44, Remove wet ceiling tile & drywall 6.00 SF 1.33 0.00 0.05 8.03
and bag -
45. Apply anti-microbial agent to the 6.00 SF 0.00 0.20 0.01 1.21
surface area
Totals: Ktichen 0.06 9.24
Line Item Totals: 2017-09-28-1500 99.29 8,382.67
2017-09-28-1500 9/28/2017 Page: 4Ist Step Restoration
5813 SW 21st
‘West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
Summary for Dwelling
Line Item Total 8,283.38
Material Sales Tax 99.29
Replacement Cost Value $8,382.67
Net Claim $8,382.67
Ist Step Restoration
2017-09-28-1500 9/28/2017 Page: 5Ist Step Restoration
5813 SW 21st
‘West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
Recap by Room
Estimate: 2017-09-28-1500
General 2,794.71 33.74%
Garage-AC 1,242.38 15.00%
Guest Bathroom 1,162.60 14.04%
Living Room 1,818.50 21.95%
Masterbath 1,256.01 15.16%
Ktiehen 9.18 0.11%
Subtotal of Areas 8,283.38 100.00%
Total 8,283.38 100.00%
2017-09-28-1500 9/28/2017 Page: 6Ist Step Restoration
5813 SW 21st
‘West Park, FL 33023
954-323-2031
[ststeprestoration@gmail.com
Recap by Category
Items Total %
CLEANING 204.24 2.44%
CONTENT MANIPULATION 61.00 0.73%
GENERAL DEMOLITION 131.67 1.57%
WATER EXTRACTION & REMEDIATION 7,886.47 94.08%
Subtotal 8,283.38 98.82%
Material Sales Tax 99.29 1.18%
Total 8,382.67 100.00%
2017-09-28-1500 9/28/2017 Page: 7Ast Step Restoration
5813 SW 21st
West Park, FL 33023
954-323-2031
Iststeprestoration@gmail.com
2017-09-28-1500 9/28/2017 Page: 8Ast Step Restoration
5813 SW 21st
West Park, FL 33023
954-323-2031
Iststeprestoration@gmail.com
2017-09-28-1500 9/28/2017 Page: 9Ist Step Restoration
5813 SW 2Ist
West Park, FL 33023
954-323-2031
Iststeprestoration@gmail.com
9/28/2017 Page: 10Ast Step Restoration
5813 SW 21st
West Park, FL 33023
954-323-2031
Iststeprestoration@gmail.com
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5813 SW 21st
West Park, FL 33023
954-323-2031
Iststeprestoration@gmail.com
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5813 SW 21st
West Park, FL 33023
954-323-2031
Iststeprestoration@gmail.com
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5813 SW 21st
West Park, FL 33023
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5813 SW 2Ist
West Park, FL 33023
954-323-2031
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5813 SW 2Ist
West Park, FL 33023
954-323-2031
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5813 SW 21st
West Park, FL 33023
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Preview
Case Number: COCE-18-000365 Division: 53 Filing # 66106213 E-Filed 01/04/2018 02:15:27 PM IN THE COUNTY COURT IN AND FOR BROWARD COUNTY, FLORIDA Civil Division Case Number: 1ST STEP RESTORATION, LLC A/A/O MOYA, JOSE & ANA Plaintiff, v. GEOVERA SPECIALTY INSURANCE COMPANY, Defendant. / COMPLAINT FOR BREACH OF CONTRACT COMES NOW, Plaintiff, Ist Step Restoration, LLC A/AO MOYA, JOSE & ANA, by and through undersigned counsel, files this Complaint for Breach of Contract and in support thereof states: 1. This is an action for Breach of Contract involving Damages which do not exceed $15,000.00, exclusive of attorney’s fees and costs wherefore this Court has subject matter jurisdiction over this matter. 2. Plaintiff is a corporation licensed to do business in the State of Florida and conducts regular business activities in BROWARD County, Florida. 3. Defendant is a corporation licensed to do business in the State of Florida and conducts regular business activities in BROWARD County, Florida. 4. Venue is proper in this action as the loss which forms the underlying factual basis of this action occurred in BROWARD County, Florida. *4* FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 1/4/2018 2:15:25 PM.****10. ll. 12. At all times material hereto, the Defendant provided insurance coverage to the Assignor’s property located 4014 Johnson Street; Hollywood, FL 33021 (hereinafter referred to as “subject property”) The insurance coverage provided by the Defendant to subject property afforded various types of coverages including coverage for damage due to water loss and mold. Plaintiff is not in possession of said policy of insurance, but Defendant has complete access to said policy. On or about 7/20/2017, the subject property was damaged as a result of water loss and mold. Plaintiff and/or Assignor have furnished Defendant with timely notice of the loss, proof of claim and have otherwise performed all conditions precedent to recover under the policy and under the applicable Florida Statutes, but the Defendant has refused and continues to refuse to pay either part or all of the Plaintiff’s claims. Upon notice of the covered loss, the Defendant assigned a claim number, to wit: HL17500704. Plaintiff provided mold remediation services to Assignor for the damages caused by water loss to the subject property. Assignor equitably assigned to Plaintiff and/or executed a written assignment of benefits, assigning to Plaintiff certain benefits payable pursuant to the policy of insurance issued by Defendant. A copy of said assignment is attached as Exhibit “AD13. 14. 15. 16. 17. 18. Pursuant to said Assignment, Plaintiff submitted its bill to Defendant. A copy of the invoice is attached as Exhibit “B”. Defendant is in breach of its contract with its insured as it has failed to pay Plaintiff's claim in full. Plaintiff has been damaged by Defendant’s breach of said contract by not being compensated in full for the repairs to the subject property. Defendant owes Plaintiff 1st Step Restoration, LLC for the balance of the money due for repairs to the subject property. As a direct and proximate result of Defendant’s refusal to pay Plaintiffs claim, Plaintiff has been required to retain the services of the undersigned attorneys to represent and protect Plaintiffs interests and Plaintiff has become obliged to pay them a reasonable fee for their services in bringing this action. In the event that Plaintiff prevails in this action, Plaintiff is entitled to an award of attorney’s fees and costs pursuant to Section 627.428, Florida Statutes as well as interest pursuant to F.S. s. 627.70131. WHEREFORE, Plaintiff demands judgment against the Defendant for damages including but not limited to: Reimbursement for its water restoration services provided to the subject property; interest as allowed by law; reasonable attorney’s fees and costs pursuant to Section 627.428 and 57.041, Florida Statutes; trial by jury of all issues triable as a matter of right by jury; any other relief this Court deems just and appropriate. FLORIDA ADVOCATES Attorneys for Plaintiff 45 Hast Sheridan Street Dania Beach, Florida 33004 Ph: (754) 263-4252 Designated: eservice@fladvocates.comBy:__/s/ Russel Lazega Florida Bar No.: 091588EXHIBIT “A”1st Step Restoration LLC Phone: (954) 323-2031 - Fax: (954) 892-6880 Toll Free: 1-866-859-3217 5815 SW 21 St. West Park, FL 33023 © www.1stStepRestoration.com CONTRACT FOR SERVICES, ASSIGNMENT OF BENEFITS, DIRECT PAYMENT AUTHORIZATION, AND HOLD HARMLESS AGREEMENT I, the Owner/Agent for the job site listed below, authorize (1st Step Restoration) (hereinafter referred to as “Company”) to enter my property, furnish materials, supply all equipment and perform all labor necessary to preserve and protect my property from further damage. ASSIGNMENT OF INSURANCE B ITS I, hereby, assign any and all insurance rights, benefits, proceeds and any causes of action under any applicable insurance policies to Company, for services rendered or to be rendered by Company. In this regard, I waive my privacy rights. I 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. I also hereby direct my insurance carrier(s) to release any and all information requested by Company, its representative, and/or it’s Attorney for the direct purpose of obtaining actual benefits to be paid for services rendered or to be rendéfed. 1 believe the appropriate insurance catrier to be (__ Cte Ly Seni LL DIRECT PAYMENT AUTHORIZATION Lalso hereby authorize and unequivocally instruct direct payment of any benefits or proceeds to Company. It is very difficult to determine the cost of the restoration until after it has been completed. The final billing will be forwarded to your insurance company for payment. I also 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. Any checks I receive for services by the insurance company will be endorsed and send to the company for their services. | 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 AUTHORIZED AN TS iCROBIAL AG! I understand that in the best judgment of Company, materials may be treated with a Commercial antimicrobial agent to inhibit the growth of micro-organisms during the drying process. I have received advanced notice of the use of antimicrobial and/or antimicrobial product as part of the restoration process. I understand it is beyond the expertise of Company to determine if someone is sensitive to its application and will hold Company harmless for its use. STOP WORK-HOLD HARMLESS In the event Company is not allowed to perform its recommended procedures and/or drying equipment is removed prematurely, I agree to release and hold Company harmless, and indemnify Company against all claims or actions that may result from such procedures. I understand that I am not responsible for any damages to appliances, furniture, structure, and future damages during remediation process. Policy #24 HORE, Address: 0% Print Name Owner/Agent: La ee. Ae ye Signature Owner/A gente OS Pes Date: DLS J? Thave read and understand the information above and have received a copy for my records.1st Step Restoration LLC Phone: (954) 323-2031 - Fax: (954) 892-6880 Toll Free: 1-866-859-3217 5815 SW 21 St. West Park, FL 33023 * www.!stStepRestoration.com ASSIGNMENT OF INSURANCE BENEFITS Client/Insured : Policy Number. CE EéE Lb E Lil S Claim Number HEA TS CO “1O4 = api Of ~ G Je Insurer EE CHLSAL x. De (7, ole oy (oxPiliieitiee 6 Date of Loss T20|i9 L ASSIGNMENT OF INSURANCE BENEFITS I, hereby, assign any and all insurance rights, benefits, proceeds and any causes of action under any applicable insurance policies to (_1st Step Restoration LLC _)(hercinafter referred to as “Company”, for services rendered or to be rendered by Company. In this regard, | waive my privacy rights. I 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. I also hereby direct my insurance carrier(s) to release any and all information requested by Company, its representative, and/orits Attorney for the direct purpose of obtaining actual benefits to be paid by my insurance carrier(s) for services aia to be rendered. I believe the appropriate insurance carrier to b PON ALE (YE II. DIRECT PAYMENT AUTHORIZATION - 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 DAY OF 520/%in ; Florida IOS fo (Print Name)Owner/Agent 7 Ee ignature) Owner/AgentEXHIBIT “B”Ist Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com Insured: Jose Moya Property: 4014 Johnson St Hollywood, FL 33021 Claim Rep.: 1st Step Restoration Company: 1 St Step Restoration Business: 5813 S.W. 21 Street West Park, FL 33023 Estimator: Ist Step Restoration Company: | St Step Restoration Business: 5813 S.W. 21 Street West Park, FL 33023 Claim Number: HL17500704 Policy Number: GH40028105 Date of Loss: 20/2017 Date Received: Date Inspected: Price List: Estimate: Date Entered: FLFL8X_SEP17 Restoration/Service/Remodel 2017-09-28-1500 Home: (954) 684-6063 Business: (954) 323-2031 E-mail: —1ststeprestoration@gmail.com Business: (954) 323-2031 E-mail: _ 1 ststeprestoration@gmail. com Type of Loss: Mold 9/28/2017 3:00 PMIst Step Restoration 5813 SW 21st ‘West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com 2017-09-28-1500 General DESCRIPTION QTY REMOVE REPLACE T. TOTAL 1. Iniital Inspection 1.00 EA 0.00 240.00 0.00 240.00 To determine the cause of loss and moisture detection by certified tech. To identify the water intrusion and the amount of damage by tech. To identify safety hazard for health and potential risk. To discuss the drying process. 3. Emergency service call - during 1.00 EA 0.00 160.00 0.00 160.00 business hours 4. Equipment setup, take down, and 6.00 HR 0.00 45.06 0.00 270.36 monitoring (hourly charge) 5. General clean - up 4.00 HR 0.00 31.13 0.00 124.52 7. Supervisory - per hr 4.00 HR 0.00 47.99 0.00 191.96 8. Equipment cleaning charge - per 5.00 EA 0.00 3131 1.22 157.77 piece of equipment 9. Xactimate Specialist 1.00 EA 0.00 375.00 0.00 375.00 10. Mortgage Processing Fee 1.00 EA 0.00 500.00, 0.00 500.00, Fee is for the time and expense to obtain the payment endorsement from the mortgage company. 20. Boots - waterproof latex - 20.00 EA 0.00 6.45 7.74 136.74 Disposable (per pair) 21. Add for personal protective 20.00 EA 0.00 18.42 22.09 390.49 equipment - Heavy duty 22. Respirator - Full face - multi- 20.00 DA 0.00 7.61 0.00 152.20 purpose resp. (per day) 3 techs 23. Respirator cartridge - HEPA only 12.00 EA 0.00 8.87 6.39 112.83 (per pair) 25. Plastic bag - used for disposal of 6.00 EA 0.00 3.38 1.22 21.50 contaminated items Totals: General 38.66 2,833.37 Garage-AC DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 11. Containment 180.00 SF 0.00 0.63 0.76 114.16 Barrier/Airlock/Decon. Chamber 12. Content Manipulation charge - per 2.00 HR 0.00 30.50 0.00 61.00 hour 14. Clean the surface area - Heavy- 144.00 SF 0.00 0.32 0.09 46.17 Wall-Ceiling 15. Clean floor 36.00 SF 0.00 0.29 0.00 10.44 2017-09-28-1500 9/28/2017 Page: 2Ist Step Restoration 5813 SW 21st ‘West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com CONTINUED - Garage-AC DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 17. Apply anti-microbial agent to the 180.00 SF 0.00 0.20 0.32 36.32 surface area 18. Negative air fan/Air scrubber (24 5.00 DA 0.00 145.00 0.00 725.00 hr period) - No monit. 19. Add for HEPA filter (for negative 1.00 EA 0.00 184.25 10.50 194.75 air exhaust fan) 24. Remove wet ceiling tile & drywall 15.00 SF 1.33 0.00 0.12 20.07 and bag 28. Peel & seal zipper - heavy duty 1.00 EA 0.00 13.26 0.63 13.89 46. Containment Barrier - tension post - 10.00 DA 0.00 3.30 0.00 33.00 per day 2 post for 5 days Totals: Garage-AC 12.42 1,254.80 Guest Bathroom DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 26. Containment 384.00 SF 0.00 0.63 1.61 243.53 Barrier/Airlock/Decon. Chamber 27. Peel & seal zipper - heavy duty 1.00 EA 0.00 13.26 0.63 13.89 29, Remove wet ceiling tile & drywall 48.00 SF 1,33 0.00 0.37 64.21 and bag - 31. Clean floor 48.00 SF 0.00 0.29 0.00 13.92 32. Apply anti-microbial agent to the 384.00 SF 0.00 0.20 0.69 77.49 surface area 33. Negative air fan/Air scrubber (24 5.00 DA 0.00 145.00 0.00 725.00 hr period) - No monit. 34. Add for dehum filter 1.00 EA 0.00 27.86 10.50 38.36 Totals: Guest Bathroom. 13.80 1,176.40 Living Room DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 35. Negative air fan/Air scrubber (24 10.00 DA 0.00 145.00 0.00 1,450.00 hr period) - No monit. 2 airscrubbers for 5 days 36. Add for HEPA filter (for negative 2.00 EA 0.00 184.25 21.00 389.50 air exhaust fan) 2017-09-28-1500 9/28/2017 Page: 3Ist Step Restoration 5813 SW 21st ‘West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com CONTINUED - Living Room DESCRIPTION QTY REMOVE REPLACE TAX TOTAL Totals: Living Room 21.00 1,839.50 Masterbath DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 37. Containment 384.00 SF 0.00 0.63 1.61 243.53 Barriet/Airlock/Decon. Chamber 38. Peel & seal zipper - heavy duty 1.00 EA 0.00 13.26 0.63 13.89 39. Remove wet ceiling tile & drywall 30.00 SF 1.33 0.00 0.23 40.13 and bag 40. Clean floor 32.00 SF 0.00 0.29 0.00 9.28 41. Apply anti-microbial agent to the 212.00 SF 0.00 0.20 0.38 42.78 surface area 42. Negative air fan/Air scrubber (24 5.00 DA 0.00 145.00 0.00 725.00 hr period) - No monit. 43. Add for HEPA filter (for negative 1.00 EA 0.00 184.25 10.50 194.75 air exhaust fan) Totals: Masterbath 13.35 1,269.36 Ktichen DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 44, Remove wet ceiling tile & drywall 6.00 SF 1.33 0.00 0.05 8.03 and bag - 45. Apply anti-microbial agent to the 6.00 SF 0.00 0.20 0.01 1.21 surface area Totals: Ktichen 0.06 9.24 Line Item Totals: 2017-09-28-1500 99.29 8,382.67 2017-09-28-1500 9/28/2017 Page: 4Ist Step Restoration 5813 SW 21st ‘West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com Summary for Dwelling Line Item Total 8,283.38 Material Sales Tax 99.29 Replacement Cost Value $8,382.67 Net Claim $8,382.67 Ist Step Restoration 2017-09-28-1500 9/28/2017 Page: 5Ist Step Restoration 5813 SW 21st ‘West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com Recap by Room Estimate: 2017-09-28-1500 General 2,794.71 33.74% Garage-AC 1,242.38 15.00% Guest Bathroom 1,162.60 14.04% Living Room 1,818.50 21.95% Masterbath 1,256.01 15.16% Ktiehen 9.18 0.11% Subtotal of Areas 8,283.38 100.00% Total 8,283.38 100.00% 2017-09-28-1500 9/28/2017 Page: 6Ist Step Restoration 5813 SW 21st ‘West Park, FL 33023 954-323-2031 [ststeprestoration@gmail.com Recap by Category Items Total % CLEANING 204.24 2.44% CONTENT MANIPULATION 61.00 0.73% GENERAL DEMOLITION 131.67 1.57% WATER EXTRACTION & REMEDIATION 7,886.47 94.08% Subtotal 8,283.38 98.82% Material Sales Tax 99.29 1.18% Total 8,382.67 100.00% 2017-09-28-1500 9/28/2017 Page: 7Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 2017-09-28-1500 9/28/2017 Page: 8Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 2017-09-28-1500 9/28/2017 Page: 9Ist Step Restoration 5813 SW 2Ist West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 9/28/2017 Page: 10Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com - 2017-09-28-1500 9/28/2017 Page: 11Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 2017-09-28-1500 9/28/2017 Page: 12Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 21 23 2017-09-28-1500 9/28/2017 Page: 13Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 25 27 2017-09-28-1500 9/28/2017 Page: 14Ist Step Restoration 5813 SW 2Ist West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 31 2017-09-28-1500 9/28/2017 Page: 15Ist Step Restoration 5813 SW 2Ist West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 34 35 36 9/28/2017 Page: 16Ist Step Restoration 5813 SW 2Ist West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 39 2017-09-28-1500 9/28/2017 Page: 17Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 41 43 2017-09-28-1500 9/28/2017 Page: 18Ist Step Restoration 5813 SW 2Ist West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 45 47 9/28/2017 Page: 19Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 49 31 2017-09-28-1500 9/28/2017 Page: 20Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 33 55 2017-09-28-1500 9/28/2017 Page: 21Ast Step Restoration 5813 SW 21st West Park, FL 33023 954-323-2031 Iststeprestoration@gmail.com 37 2017-09-28-1500 9/28/2017 Page: 22