I do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of all applicable claims for the loss or damage listed above including representation on my behalf with the Department of Insurance. CLAIM CRUSHERS LLC is hereby hired as a Public Adjuster and is obligated under our Public Adjuster licenses to serve with objectivity and complete loyalty to the interest of our client alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’S knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest pursuant to O.C.G.A. § 33-23-43.2.

The duties of the Public Adjuster shall be limited to assisting in proving the loss and coverage where applicable by the first named insured’s policy and determining the value of the loss covered by that same policy. Insured agrees to assist CLAIM CRUSHERS LLC in the processing of the insured’s claim. All information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true.

The insured agrees to pay CLAIM CRUSHERS LLC for such services, a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % of all insurance proceeds payable under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible plus expenses, direct costs, or any other costs accrued by CLAIM CRUSHERS LLC outside of the normal course of business. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees. CLAIM CRUSHERS LLC’S fee shall be due as a percentage of each draft or check when collected from the insurance carrier at the rate listed in this contract.

Interest Disclosure: The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, or any other firm or business entity that performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster or disclosure of any other activities that may be reasonably construed as a conflict of interest, including a financial interest in any salvage, repair, construction, or restoration of any business entity that obtains business in connection with any claims that the public adjuster has a contract or agreement to adjust (which is specifically prohibited in 33-23-43.8 (g)). The public adjuster does not have any direct or indirect compensation of value in connection with an insured’s specific loss other than compensation from the insured for service as a public adjuster.

WE REPRESENT THE INSURED ONLY.

Payment Disclosure: Insured may direct CLAIM CRUSHERS LLC to make disbursements to 3rd party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction of pay is requested, the insured will remain an endorsee on the draft.

Prior to initiating any contact with the insured’s insurer, the insurer’s adjuster, or the insurer’s attorney regarding settlement of the insured’s claim, a public adjuster must provide the insurer a notification letter signed by the insured confirming that the insured has authorized the public adjuster to communicate directly with the insurer, the insurer’s adjuster, or the insurer’s attorney on behalf of the insured. This agreement does not restrict the insured’s right to initiate and maintain direct communications with the insured’s attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding settlement of the insured’s claim or from pursuing any civil remedies relating to the claim.

Authorization to Endorse on Behalf of Insured: Insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’S escrow or trust account. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds. Any distribution of such funds to the insured or CLAIM CRUSHERS LLC will be accompanied by a detailed breakdown of the funds distributed. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC pursuant to O.C.G.A. 33-23-43.3(e).

By signing this agreement, the insured hereby authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on behalf of the insured as the insured’s representative.

By signing this contract, I attest that my license, as issued by the Georgia Office of Insurance and Safety Fire Commission is valid and in full force and effect as of the date of signing this contract and that I am bonded as a Public Adjuster pursuant to State Law.

NOTICE OF RIGHT TO CANCEL: You, the insured, may cancel this contract at any time prior to midnight of the 3rd business day after the date of execution of this contract. Such rescission shall be in writing and mailed or delivered to the public adjuster at the address stated in the contract within 3 business days. The rescission shall be deemed delivered or mailed if it is delivered by electronic transmittal to the email address or facsimile specified in the contract. If you exercise your right to cancel this contract, anything of value given by you under the contract will be returned to you within fifteen (15) business days following receipt of this notice. You will be liable for reasonable and necessary emergency out-of-pocket expenses or services which were paid or incurred by CLAIM CRUSHERS LLC to protect the interests of the insured during the period preceding cancellation. To cancel this contract deliver in person a written notice indicating your intent to cancel and the date thereof to CLAIM CRUSHERS LLC at: 9924 Davis St, STE 1, Braselton, GA 30517 or by email at admin@crushingclaims.com. Should the insured wish to cancel the contract at any time outside the 3rd business day rescission period, notice of wish to cancel shall be in writing and delivered as stated above. If CLAIM CRUSHERS LLC consents to any cancellation of contract, insured shall be liable and responsible for all time and expenses incurred at a rate $350.00 per hour or $575.00, whichever is greater, only if accepted by CLAIM CRUSHERS LLC.

Limited Power of Attorney

does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517 to be its true and lawful attorney in fact irrevocably in its place and in its stead to: Endorse insurance proceeds checks made payable to Principal and possibly other parties so that those checks may be deposited to Claim Crushers, LLC. Client Funds Account (for checks that include any money owed to client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC., pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal and Principal does hereby undertake and agree at all times to ratify, whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC. to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC. in connection with any action that they may take in reliance or in connection with this Power of Attorney.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Tennessee Department of Commerce and Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with Tenn. Code Ann. § 56-6-901 et seq. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss after the date of this contract, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. Fee limits under Tenn. Code Ann. § 56-6-913 (residential, non commercial claims): if this contract is formed before the insurer has made an offer of settlement, the fee shall not exceed fifteen percent (15%) of the total proceeds of the insurance settlement; if this contract is formed after the insurer has made an offer of settlement, the fee shall not exceed twenty five percent (25%) of the difference between the insurer’s last offer before this contract and the final amount of proceeds obtained after CLAIM CRUSHERS LLC entered this contract; if the insured has a home mortgage of 100% of the appraised value of the home, the fee on a policy limit total loss occurring during a catastrophic disaster within the first twelve months of the mortgage shall not exceed ten percent (10%); and no fee is charged on any advance payment made by the insurer before the date of this contract. No fee, retainer, compensation, deposit, or other thing of value will be required, demanded, or accepted before settlement of the claim. If the insurer, not later than 72 hours after the date on which the loss is reported to the insurer, either pays or commits in writing to pay the policy limit of the insurance policy, CLAIM CRUSHERS LLC will not receive a commission consisting of a percentage of the amount paid by the insurer, will inform the insured that the amount of any recovery might not be increased, and will be entitled only to reasonable compensation from the insured based on the time spent on the claim and the expenses incurred, until the claim is paid or the insured receives a written commitment to pay from the insurer (Tenn. Code Ann. § 56-6-914(b)). Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees. Initial expenses to be reimbursed to CLAIM CRUSHERS LLC from the proceeds of the claim payment, specified by type with dollar estimates (write NONE if none): . Any additional expense must first be approved by the insured in writing.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by Tenn. Code Ann. §§ 56-6-914(c) and 56-6-915. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) Your insurance company has the right to communicate with you even though you have hired a public adjuster; if you request it, the insurance company will make a concerted effort to include CLAIM CRUSHERS LLC in communications with you.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Before initiating contact with the insurer regarding settlement of the claim, CLAIM CRUSHERS LLC will provide the insurer a notification letter signed by the insured authorizing CLAIM CRUSHERS LLC to represent the insured’s interest (Tenn. Code Ann. § 56-6-914(g)); a signed Notice of Representation is attached for that purpose. By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued to the insured, limited to endorsement for deposit only into CLAIM CRUSHERS LLC’s escrow or trust account at a federally insured financial institution. The check or payment will be distributed in the percentages or amounts agreed upon in this contract, the insured will be notified of the deposit of funds, and any distribution will be accompanied by a detailed written breakdown of the funds distributed. This contract does not require or request that CLAIM CRUSHERS LLC’s name appear on the issuance of any check (Tenn. Code Ann. § 56-6-914(d)(2)). This authorization may be revoked at any time by the insured upon written notice to CLAIM CRUSHERS LLC.

NOTICE OF RIGHT TO RESCIND (Tenn. Code Ann. § 56-6-914(h) and (i)) You, the insured, have the right to rescind this contract within three (3) business days after the date the contract was signed. The rescission shall be in writing and mailed or delivered to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailed to PO Box 579, Braselton, GA 30517, or emailed to admin@crushingclaims.com) within the three business day period. If you exercise your right to rescind this contract, anything of value given by you to CLAIM CRUSHERS LLC under the contract will be returned to you within three (3) business days after CLAIM CRUSHERS LLC receives your cancellation notice.

Cancellation after the rescission period. The insured may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the insured cancels after the rescission period, CLAIM CRUSHERS LLC shall be entitled to reasonable compensation for the documented services it performed through the date of cancellation, payable only from insurance proceeds when and as they are paid by the insurer on the claim, not to exceed the limits stated above. No fee is payable before settlement of the claim.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. The insured will be given a copy or the original of this contract at the time of signing (Tenn. Code Ann. § 56-6-914(f)).

By signing this agreement, the insured acknowledges receipt of the separate Public Adjuster Disclosure Document before signing, acknowledges reading this entire contract including the right to rescind, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the Tennessee Department of Commerce and Insurance, that my full name shown here is as reflected in the records on file with the Commissioner, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster is fully bonded pursuant to Tenn. Code Ann. Title 56, Chapter 6, Part 9 (Tenn. Code Ann. § 56-6-914(a)(10)).

PUBLIC ADJUSTER DISCLOSURE DOCUMENT (provided to the insured before signing the contract)

This separate disclosure is provided to the insured before the Public Adjuster Contract is signed, as required by Tenn. Code Ann. § 56-6-914(e).

(1) An insured is obligated to present the insured’s claim to an insurance company in the manner set forth in the insurance contract as required by law. The insured and the insurer shall act in good faith toward the other as required by law. There are three (3) types of adjusters that could be involved in that process. The definitions of the three (3) types are as follows:

(A) “Company adjuster” means the insurance adjusters that are employees of an insurance company. The adjusters are paid by the insurance company and will not charge the insured a fee;

(B) “Independent adjuster” means the insurance adjusters that are hired on a contract basis by an insurance company in the settlement of the claim. The adjusters are paid by the insured’s insurance company and will not charge the insured a fee; and

(C) “Public adjuster” means the insurance adjusters that do not work for any insurance company. The adjusters work for the insured in connection with the insured’s claim against the insured’s insurance carrier. The insured hires the adjusters by signing a contract agreeing to pay the adjusters a fee or commission based on a percentage of the settlement, or other method of compensation;

(2) The insured is not required to hire a public adjuster to help the insured meet the insured’s obligations under the policy, but has a right to do so;

(3) The insured has the right to initiate direct communications with the insured’s attorney, the insurer, the insurer’s adjuster, and the insurer’s attorney, or any other person regarding the settlement of the insured’s claim;

(4) The public adjuster is not a representative or employee of the insurer;

(5) The salary, fee, commission or other consideration is the obligation of the insured, not the insurer; and

(6) An insurance company has the right to communicate with its insured, even if the insured has hired a public adjuster; but, if requested by the insured, the insurance company will make a concerted effort to include the public adjuster in communications with the insured.

I/We acknowledge that I/we received and read this disclosure before signing the Public Adjuster Contract with CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): License #: Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Tennessee, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Tennessee: this signed notification letter is provided to the insurer before the public adjuster initiates contact with the insurer regarding settlement (Tenn. Code Ann. § 56-6-914(g)). Nothing in this letter requests that the public adjuster’s name be placed on any check.

Public adjuster handling this claim: TN License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s Client Funds escrow or trust account at a federally insured financial institution (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the South Carolina Department of Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with S.C. Code Ann. § 38-48-10 et seq. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving and documenting the loss and determining the value of the loss under the first named insured’s policy. CLAIM CRUSHERS LLC will not offer or provide advice as to whether the claim is covered by the policy; coverage decisions are made by the insurer. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. THE FEE DUE TO CLAIM CRUSHERS LLC SHALL BE PAID BY THE INSURED FROM ANY SUMS CLAIM CRUSHERS LLC ASSISTS THE INSURED IN RECOVERING AND IS NOT PAID BY THE INSURER. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees.

Referral disclosure. CLAIM CRUSHERS LLC has not entered into any agreement with another licensed public adjuster for the referral of this claim or the sharing of compensation on it, except as stated here (write NONE if none): . CLAIM CRUSHERS LLC will not act as a contractor on this loss and will not solicit or enter into any agreement for the repair or replacement of the damaged property.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by S.C. Code Ann. §§ 38-48-70 and 38-48-130. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Promptly after this contract is executed and after the time to rescind has elapsed, CLAIM CRUSHERS LLC will give written notice to the insurer or its adjuster or representative that it has entered into this written contract with the insured (a signed Notice of Representation is attached for that purpose). By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf once that notice has been given.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s escrow or trust account at a federally insured financial institution. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

NOTICE OF RIGHT TO RESCIND (S.C. Code Ann. §§ 38-48-80 and 38-48-110)

You, the insured, may rescind this contract at any time until the close of business on the fifth (5th) business day after you sign it. To rescind, deliver a signed and dated written notice stating that you are rescinding this contract to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailed to PO Box 579, Braselton, GA 30517, or emailed to admin@crushingclaims.com). If you rescind, anything of value given by you under this contract will be returned to you within fifteen (15) business days after CLAIM CRUSHERS LLC receives your notice. Rescission date deadline (fifth business day after signing): .

Optional waiver (non primary residence or commercial property only). If the insured property is not the insured’s primary residence and is not used primarily for personal, family, or household purposes, the insured may waive the right to rescind by signing here: Date:

Cancellation after the rescission period. The insured may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the insured cancels after the rescission period, the insured shall pay CLAIM CRUSHERS LLC for its time and expenses incurred through the date of cancellation at the rate of $350.00 per hour or $575.00, whichever is greater, payable from any insurance proceeds recovered on the claim.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties.

By signing this agreement, the insured acknowledges reading this entire contract, including the right to rescind, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above. Date signed by both parties:

Public Adjuster: By signing this contract, I attest that my South Carolina public adjuster license, as issued by the South Carolina Department of Insurance, is valid and in full force and effect as of the date of signing, that my full name and address shown here are as recorded with the Department, and that I am bonded as required by law.

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of South Carolina, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

South Carolina timing: this notice is given to the insurer promptly after the contract is executed and after the five business day rescission period has elapsed (S.C. Code Ann. § 38-48-80).

Public adjuster handling this claim: SC License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s Client Funds (escrow or trust) Account at a federally insured financial institution (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the North Carolina Department of Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with N.C. Gen. Stat. § 58-33A-1 et seq. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. In accordance with N.C.G.S. § 58-33A-60(d), in the event of a catastrophic incident the total compensation and reimbursement charged on the claim shall not exceed ten percent (10%) of any insurance settlement or proceeds, and no fee, retainer, compensation, deposit, or other thing of value will be required, demanded, or accepted before settlement of the claim. If the insurer, not later than 72 hours after the date on which the loss is reported to the insurer, either pays or commits in writing to pay the policy limit of the insurance policy, CLAIM CRUSHERS LLC will not receive a commission consisting of a percentage of the amount paid by the insurer, will inform the insured that the loss recovery amount might not be increased by the insurer, and will be entitled only to reasonable compensation from the insured based on the time spent on the claim and the expenses incurred, until the claim is paid or the insured receives a written commitment to pay from the insurer (N.C.G.S. § 58-33A-65(c)). Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees. Initial expenses to be reimbursed to CLAIM CRUSHERS LLC from the proceeds of the claim payment, specified by type with dollar estimates (write NONE if none): . Any additional expense must first be approved by the insured in writing.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by N.C.G.S. §§ 58-33A-65(d) and 58-33A-80. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Before initiating contact with the insurer regarding settlement of the claim, CLAIM CRUSHERS LLC will provide the insurer a notification letter signed by the insured authorizing CLAIM CRUSHERS LLC to represent the insured’s interest (N.C.G.S. § 58-33A-65(h)); a signed Notice of Representation is attached for that purpose. By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s non interest bearing escrow or trust account at a financial institution insured by an agency of the federal government, as required by N.C.G.S. § 58-33A-70. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

NOTICE OF RIGHT TO RESCIND (N.C.G.S. § 58-33A-65(i) and (j))

You, the insured, have the right to rescind this contract within three (3) business days after the date the contract was signed. The rescission shall be in writing and mailed or delivered to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailed to PO Box 579, Braselton, GA 30517, or emailed to admin@crushingclaims.com) within the three business day period. If you exercise your right to rescind this contract, anything of value given by you under the contract will be returned to you within fifteen (15) business days after CLAIM CRUSHERS LLC receives your cancellation notice.

Cancellation after the rescission period. The insured may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the insured cancels after the rescission period, CLAIM CRUSHERS LLC shall be entitled to reasonable compensation for the documented services it performed through the date of cancellation, payable only from insurance proceeds when and as they are paid by the insurer on the claim, not to exceed the percentage stated in this contract applied to those proceeds. No fee is payable before settlement of the claim.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties.

By signing this agreement, the insured acknowledges receipt of the separate Public Adjuster Disclosure Document before signing, acknowledges reading this entire contract including the right to rescind, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the North Carolina Department of Insurance, that my full name shown here is as specified in Department records, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster is fully bonded pursuant to State law (N.C.G.S. § 58-33A-65(a)(10)).

PUBLIC ADJUSTER DISCLOSURE DOCUMENT (provided to the insured before signing the contract)

This separate disclosure is provided to the insured before the Public Adjuster Contract is signed, as required by N.C.G.S. § 58-33A-65(f).

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

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

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

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

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

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

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

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

I/We acknowledge that I/we received and read this disclosure before signing the Public Adjuster Contract with CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): License #: Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of North Carolina, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

North Carolina: this signed notification letter is provided to the insurer before the public adjuster initiates contact with the insurer regarding settlement (N.C.G.S. § 58-33A-65(h)).

Public adjuster handling this claim: NC License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s non interest bearing Client Funds escrow or trust account at a federally insured financial institution (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Maryland Insurance Administration. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with Md. Code Ann., Ins. §§ 10-401 through 10-416. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. If the compensation is based on a share of the insurance settlement, the exact percentage is the percentage stated above (Ins. § 10-411(b)(2)). If the insurer, within 72 hours after the time the loss is reported to the insurer, either pays or commits in writing to pay the policy limit of the insurance policy, CLAIM CRUSHERS LLC may not receive a commission consisting of a percentage of the amount paid by the insurer, will inform the insured that the loss recovery amount might not be increased by the insurer, and may be entitled only to reasonable compensation based on the time spent on the claim and the expenses incurred, until the claim is paid or the insured receives a written commitment to pay from the insurer (Ins. § 10-411(c)). Notice regarding expenses (Ins. § 10-411(a)(3)(ix)): the public adjuster may incur out of pocket expenses on behalf of the insured, and those expenses incurred by the public adjuster and approved by the insured will be reimbursed to the public adjuster from the insurance proceeds. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by Md. Code Ann., Ins. §§ 10-411(d), 10-414, and 10-415. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

The disclosure above also covers any direct or indirect financial interest that any immediate family member of the public adjuster has with any other party involved in any aspect of the claim (Ins. § 10-411(d)). Signed: Insured Public Adjuster Date

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) A public adjuster, or anyone acting on behalf of a public adjuster, may not solicit or attempt to solicit a client between the hours of 8:00 p.m. and 8:00 a.m. (Ins. § 10-414(e)).

(6) Maryland Consumer Protection Act notice (Ins. § 10-411(i)): you have rights under the Maryland Consumer Protection Act, Md. Code Ann., Com. Law § 13-101 et seq., including the right to be free from unfair, abusive, or deceptive trade practices and the right to file a complaint with the Consumer Protection Division of the Office of the Attorney General, 200 St. Paul Place, Baltimore, MD 21202, 410-528-8662. You may also contact the Maryland Insurance Administration, 200 St. Paul Place, Suite 2700, Baltimore, MD 21202, 410-468-2000.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Before initiating contact with the insurer regarding settlement of the claim, CLAIM CRUSHERS LLC will provide the insurer a notification letter signed by the insured authorizing CLAIM CRUSHERS LLC to represent the insured’s interest; a signed Notice of Representation is attached for that purpose. By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf. If this contract is entered into during, or within 72 hours after, the loss giving rise to the claim, CLAIM CRUSHERS LLC will notify the Maryland Insurance Commissioner of the contract within one business day as required by Ins. § 10-414(f).

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s non interest bearing escrow or trust account at a federally insured financial institution, as required by Ins. § 10-412. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

NOTICE OF RIGHT TO RESCIND OR CANCEL (Md. Code Ann., Ins. § 10-411(h))

You, the insured, have the right to rescind or cancel this contract within ten (10) business days after the date the contract was signed. The notice of rescission or cancellation shall be in writing and mailed or delivered to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailed to PO Box 579, Braselton, GA 30517, or emailed to admin@crushingclaims.com) within that ten business day period. If you exercise your right to rescind or cancel this contract, CLAIM CRUSHERS LLC shall, within fifteen (15) business days after it receives the notice, return anything of value given by you under this contract. A business day is any calendar day other than a Saturday, Sunday, or State holiday.

Cancellation after the rescission period. The insured may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the insured cancels after the rescission period, CLAIM CRUSHERS LLC shall be entitled to reasonable compensation for the documented services it performed through the date of cancellation, payable only from insurance proceeds when and as they are paid by the insurer on the claim, not to exceed the percentage stated in this contract applied to those proceeds.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. A contract with an electronic signature constitutes an original contract (Ins. § 10-411(g)(3)).

By signing this agreement, the insured acknowledges receipt of the separate signed Disclosure Document before signing, acknowledges reading this entire contract including the right to rescind or cancel, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the Maryland Insurance Administration, that my full name shown here is as specified in the records of the Administration, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster is bonded as required by Maryland law.

PUBLIC ADJUSTER DISCLOSURE DOCUMENT (separate document signed by the insured before the contract is signed)

This separate disclosure is provided to the insured before the Public Adjuster Contract is signed, as required by Md. Code Ann., Ins. § 10-411(f).

“(1) Property insurance policies obligate the insured to present a claim to the insurance company for consideration. There are three types of adjusters that could be involved in that process. The definitions of the three types are:

(i) “Company adjuster” means an insurance adjuster who is an employee of an insurance company. A company adjuster represents the interest of the insurance company and is paid by the insurance company. A company adjuster will not charge you a fee.

(ii) “Independent adjuster” means an insurance adjuster who is hired on a contractual basis by an insurance company to represent the insurance company’s interest in the settlement of the claim. An independent adjuster is paid by your insurance company. An independent adjuster will not charge you a fee.

(iii) “Public adjuster” means an insurance adjuster who does not work for any insurance company. A public adjuster works for the insured to assist in the preparation, presentation, and settlement of a claim. The insured hires a public adjuster by signing a contract agreeing to pay the public adjuster a fee or commission based on a percentage of the settlement, or another method of compensation.

(2) The insured is not required to hire a public adjuster to help the insured meet the insured’s obligations under the policy but has the right to do so.

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

(4) A public adjuster is not a representative or an employee of the insurer.

(5) The salary, fee, commission, or other consideration of a public adjuster is the obligation of the insured, not the insurer.”

I/We acknowledge that I/we received and read this disclosure before signing the Public Adjuster Contract with CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): License #: Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Maryland, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Maryland: this signed notification letter authorizes the public adjuster to communicate with the insurer on the insured’s behalf; the public adjuster keeps a copy with the claim file (Ins. § 10-413).

Public adjuster handling this claim: MD License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s non interest bearing Client Funds escrow or trust account at a federally insured financial institution as required by Md. Code Ann., Ins. § 10-412 (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC. This Power of Attorney does not vest in Claim Crushers, LLC any authority to choose who shall perform any repair work (Ins. § 10-415).

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Virginia State Corporation Commission, Bureau of Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with Va. Code § 38.2-1845.1 et seq. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss after the date of this contract, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. In accordance with Va. Code § 38.2-1845.14: no fee, retainer, compensation, deposit, or thing of value will be required, demanded, or accepted before the settlement of the claim; the fee is fair and reasonable in relation to the work performed and includes CLAIM CRUSHERS LLC’s own costs of estimating and settling the claim; in the event of a catastrophic disaster the total fee and reimbursement shall not exceed ten percent (10%) of any insurance settlement proceeds; and no fee is charged on any amount paid by the insurer to the policyholder before the date of this contract. If the insurer, not later than 72 hours after the date on which the loss is reported to the insurer, either pays or commits in writing to pay the policy limit of the insurance policy, CLAIM CRUSHERS LLC will not receive a commission consisting of a percentage of the amount paid by the insurer, will inform the policyholder that the loss recovery amount represents the maximum amount recoverable under the policy, and will be entitled only to reasonable compensation based on the time spent on the claim and the expenses incurred. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees. Initial expenses to be reimbursed to CLAIM CRUSHERS LLC from the proceeds of the claim payment, specified by type with dollar estimates (write NONE if none): . Any additional expense must first be approved by the insured in writing.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by Va. Code § 38.2-1845.1 et seq. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) You may contact the Virginia State Corporation Commission, Bureau of Insurance (P.O. Box 1157, Richmond, VA 23218; 804-371-9631; scc.virginia.gov) to confirm the licensing status of CLAIM CRUSHERS LLC and the signing public adjuster.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. CLAIM CRUSHERS LLC will provide the insurer a notification letter signed by the policyholder authorizing CLAIM CRUSHERS LLC to represent the policyholder’s interest (Va. Code § 38.2-1845.13(C)); a signed Notice of Representation is attached for that purpose. By signing this contract the policyholder authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the policyholder’s behalf.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s escrow or trust account at a federally insured financial institution maintained in accordance with Va. Code § 38.2-1845.16. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

NOTICE OF RIGHT TO RESCIND (Va. Code § 38.2-1845.13(A)(12))

You, the policyholder, have the right to rescind this contract within three (3) business days after you sign it, or, if this contract arises from a catastrophic disaster, within five (5) business days after you sign it. The rescission shall be in writing and mailed or delivered to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailed to PO Box 579, Braselton, GA 30517, or emailed to admin@crushingclaims.com). Within fifteen (15) business days after receiving your notice to rescind, CLAIM CRUSHERS LLC will return to you anything of value given by you under this contract.

Cancellation after the rescission period. The policyholder may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the policyholder cancels after the rescission period, CLAIM CRUSHERS LLC shall be entitled to reasonable compensation for the documented services it performed through the date of cancellation, payable only from insurance proceeds when and as they are paid by the insurer on the claim, not to exceed the percentage stated in this contract applied to those proceeds. No fee is payable before settlement of the claim, and nothing in this contract prevents the policyholder from pursuing any civil remedy after the rescission period.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. A description of the services and all terms and conditions of the engagement are stated in this contract (Va. Code § 38.2-1845.13(A)(7)).

By signing this agreement, the policyholder acknowledges receipt of the separate Public Adjuster Disclosure Document, acknowledges reading this entire contract including the right to rescind, and authorizes CLAIM CRUSHERS LLC to act as the policyholder’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the Virginia State Corporation Commission, that my full name and license number shown here are as specified in the records of the Commission, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster is fully bonded pursuant to state law (Va. Code § 38.2-1845.13(A)(10)).

PUBLIC ADJUSTER DISCLOSURE DOCUMENT (provided to the insured before signing the contract)

This separate disclosure is provided to the insured before the Public Adjuster Contract is signed, as required by Va. Code § 38.2-1845.13(B).

(i) The policyholder is not required to hire a public adjuster but has the right to do so.

(ii) The public adjuster is not an employee or representative of the insurer.

(iii) The salary, fee, commission, or other consideration is the obligation of the policyholder, not the insurer.

(iv) Property insurance policies obligate the policyholder to present a claim to the insurer for consideration.

(v) The policyholder has the right to initiate direct communications with the policyholder’s attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, and any other person regarding the settlement of the policyholder’s claim.

(vi) The policyholder may contact the State Corporation Commission, Bureau of Insurance, for the licensing status of the public adjuster: P.O. Box 1157, Richmond, VA 23218; 1300 E. Main Street, Richmond, VA 23219; 804-371-9631; scc.virginia.gov.

I/We acknowledge that I/we received and read this disclosure before signing the Public Adjuster Contract with CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): License #: Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Virginia, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Virginia: this signed notification letter is provided to the insurer to authorize the public adjuster to represent the policyholder’s interest (Va. Code § 38.2-1845.13(C)).

Public adjuster handling this claim: VA License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s Client Funds escrow or trust account at a federally insured financial institution maintained in accordance with Va. Code § 38.2-1845.16 (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the New Jersey Department of Banking and Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with N.J.S.A. 17:22B-1 et seq. (including N.J.S.A. 17:22B-13 and 17:22B-13.1) and N.J.A.C. 11:1-37.13. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

“A public adjuster is hereby retained by the above-named insured to advise and assist in the adjustment of a property damage insurance claim, which services may include evaluation, documentation, presentation and negotiation of the insurance claim arising from the loss described herein.” “Any services provided by the public adjuster shall be accounted for with the specific nature of the work performed supported by a record of that work.” (N.J.S.A. 17:22B-13.1(a)(10)).

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. Maximum fees and formula for costs (N.J.A.C. 11:1-37.13(b)): the maximum fee for the services listed above is the percentage stated, which is reasonably related to the services rendered; CLAIM CRUSHERS LLC’s percentage fee is collected only as a percentage of each payment actually issued by the insurer and never in full from the first payment where the insurer will pay the claim in two or more payments. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by N.J.S.A. 17:22B-1 et seq. and N.J.A.C. 11:1-37.14. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) No public adjuster may solicit the adjustment of a loss, or enter into any contract with an insured, between the hours of 6:00 p.m. and 8:00 a.m. during the 24 hours after the loss has occurred (N.J.S.A. 17:22B-13(a) and (b)); the date and time of signing are recorded below.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. CLAIM CRUSHERS LLC will give the insurer written notice of its representation (a signed Notice of Representation is attached for that purpose). By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s escrow account in a banking institution or savings and loan association located in New Jersey and insured by an agency of the federal government, as required by N.J.S.A. 17:22B-13(f); any funds held in escrow, together with any interest, are the property of the insured until disbursed under this contract. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

RIGHT TO CANCEL OR TERMINATE (N.J.S.A. 17:22B-13.1)

“The insured may cancel this contract before midnight of the third business day after signing the contract without further obligation by completing the attached notice of right to cancel. After that time if the contract is terminated by the insured, the insured remains obligated to pay from any insurance proceeds recovered, either prior to or after the date of termination, a fee for the reasonable value of services provided by the public adjuster based upon the nature of services performed supported by a record of that work.”

Procedure to cancel or terminate: mail, fax, email, or personally deliver a signed and dated copy of the attached Notice of Right to Cancel or Terminate, or any other written notice stating your intent and the date, to CLAIM CRUSHERS LLC at the address shown at the top of this contract (9924 Davis St, STE 1, Braselton, GA 30517; mailing address PO Box 579, Braselton, GA 30517; email admin@crushingclaims.com). Rights and obligations if cancelled or terminated at any time: if you cancel within three business days, you owe nothing further except approved and itemized emergency out of pocket expenses, and anything of value you gave will be returned within 10 business days; if you terminate after that time, you owe from insurance proceeds recovered a fee for the reasonable value of the documented services performed, which the parties agree will be computed at $350.00 per hour of documented work, not to exceed the percentage stated in this contract applied to the proceeds recovered, and CLAIM CRUSHERS LLC will provide you an itemized statement of those services and the record of that work.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. This contract conforms to the Consumer Contracts Act, N.J.S.A. 56:12-1 et seq., is written in plain language, and a fully executed copy is provided to the insured upon execution (N.J.A.C. 11:1-37.13(b)).

By signing this agreement, the insured acknowledges receipt of the attached Notice of Right to Cancel or Terminate, acknowledges reading this entire contract, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the New Jersey Department of Banking and Insurance, that the license numbers shown in this contract are current, that the license is valid and in full force and effect as of the date and time of signing, and that the public adjuster is bonded as required by New Jersey law.

NOTICE OF RIGHT TO CANCEL OR TERMINATE (N.J.S.A. 17:22B-13.1(b))

This notice is attached to the Public Adjuster Contract with CLAIM CRUSHERS LLC, 9924 Davis St, STE 1, Braselton, GA 30517 (mailing address PO Box 579, Braselton, GA 30517; email admin@crushingclaims.com). A fully executed copy is provided to the insured.

NOTICE OF RIGHT TO CANCEL OR TERMINATE Copy 1 of 2 (insured keeps)

Date of Contract: Name of Insured/s:

You may cancel this contract, without further penalty or obligation, prior to midnight of the third business day after the above date. After that time, you may terminate this contract at any time. If you exercise your right to cancel this contract prior to midnight on the third business day, you will remain liable for reasonable expenses and necessary emergency out of pocket expenses or services the public adjuster incurred on your behalf that were necessary to protect your investment between signing of the contract and cancellation, if the expenses or services were approved by you. If your public adjuster seeks reimbursement from you for such out of pocket expenses or services, your public adjuster shall provide you with an itemized statement of those expenses.

If you cancel, any money or anything of value given by you to the public adjuster under the contract will be returned within 10 business days following the receipt by the public adjuster of your cancellation notice, and any security interest arising out of the contract will be canceled.

If you terminate this contract after midnight on the third business day, you are obligated to pay from any insurance proceeds recovered, either prior to or after the date of termination, a fee for the reasonable value of services provided by the public adjuster based upon the nature of the services performed by the public adjuster supported by a record of that work. If your public adjuster seeks such payment from you for the reasonable value of such services, your public adjuster shall provide you with an itemized statement of those services and the record of such work.

To cancel this contract, mail, fax, email, or personally deliver a signed and dated copy of this notice, or any other written notice, indicating your intent to cancel and date of cancellation, to the address of public adjuster shown at the top of the public adjuster contract, no later than midnight of To terminate this contract after that time, mail, fax, email, or personally deliver a signed and dated copy of this notice, or any other written notice, indicating your intent to terminate and the date of termination.

I HEREBY CANCEL / TERMINATE THIS CONTRACT

Insured: Insured: Adjuster: Please Print Name Date:

NOTICE OF RIGHT TO CANCEL OR TERMINATE Copy 2 of 2 (return to the public adjuster if cancelling or terminating) Date of Contract: _____ / _____ / _____ Name of Insured/s: ________________________________________

You may cancel this contract, without further penalty or obligation, prior to midnight of the third business day after the above date. After that time, you may terminate this contract at any time. If you exercise your right to cancel this contract prior to midnight on the third business day, you will remain liable for reasonable expenses and necessary emergency out of pocket expenses or services the public adjuster incurred on your behalf that were necessary to protect your investment between signing of the contract and cancellation, if the expenses or services were approved by you. If your public adjuster seeks reimbursement from you for such out of pocket expenses or services, your public adjuster shall provide you with an itemized statement of those expenses.

If you cancel, any money or anything of value given by you to the public adjuster under the contract will be returned within 10 business days following the receipt by the public adjuster of your cancellation notice, and any security interest arising out of the contract will be canceled.

If you terminate this contract after midnight on the third business day, you are obligated to pay from any insurance proceeds recovered, either prior to or after the date of termination, a fee for the reasonable value of services provided by the public adjuster based upon the nature of the services performed by the public adjuster supported by a record of that work. If your public adjuster seeks such payment from you for the reasonable value of such services, your public adjuster shall provide you with an itemized statement of those services and the record of such work.

To cancel this contract, mail, fax, email, or personally deliver a signed and dated copy of this notice, or any other written notice, indicating your intent to cancel and date of cancellation, to the address of public adjuster shown at the top of the public adjuster contract, no later than midnight of To terminate this contract after that time, mail, fax, email, or personally deliver a signed and dated copy of this notice, or any other written notice, indicating your intent to terminate and the date of termination.

I HEREBY CANCEL / TERMINATE THIS CONTRACT

Insured: Insured: Adjuster: Please Print Name Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of New Jersey, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

New Jersey: written notice of the public adjuster’s representation is given to the insurer after the contract is signed.

Public adjuster handling this claim: NJ License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to an escrow account maintained by Claim Crushers, LLC in a banking institution or savings and loan association located in New Jersey and insured by an agency of the federal government, as required by N.J.S.A. 17:22B-13(f) (for checks that include any money owed to the client), or to Claim Crushers, LLC’s Operating Account (for checks that are for public adjuster’s fees and costs only after disbursement to the client). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

NOTICE OF RIGHT TO CANCEL

You, the insured, may cancel this contract at any time prior to midnight of the fourth calendar day after the execution date of this contract. If you exercise your right to cancel this contract, you will be liable for reasonable and necessary emergency out of pocket expenses or services which were paid for or incurred by the public adjuster to protect the interests of the insured during the period preceding cancellation.

If you cancel this contract, anything of value given by you under the contract will be returned to you within 15 business days following the receipt by the public adjuster of your cancellation notice, and any security interest arising out of the contract will be cancelled. To cancel this contract, mail, fax or deliver in person a signed and dated copy of this notice or any other written notice, indicating your intent to cancel and the date thereof to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailing address PO Box 579, Braselton, GA 30517; email admin@crushingclaims.com) not later than midnight of (date entered by the public adjuster, not earlier than the fourth business day following the execution date). I hereby cancel this contract.

(Date) (Insured Signature)

Act 21 Disclosures (63 P.S. § 1605(a.2)). Each item must be separately initialed by the insured and by the public adjuster.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Pennsylvania Insurance Department. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with 63 P.S. § 1601 et seq. and 31 Pa. Code Chapter 115. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing within five (5) business days so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. The consideration is expressed as this percentage of any payments received on the negotiated claim (31 Pa. Code § 115.2(a)(4)). Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by 63 P.S. § 1601 et seq. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

CLAIM CRUSHERS LLC will not, directly or indirectly or through any person or entity in which it has an interest, enter into any contract with the insured for the repair, replacement, restoration, renovation, or demolition of the damaged property before a verdict or award is entered or payment is received from the insurer (63 P.S. § 1605(d)). CLAIM CRUSHERS LLC will provide the insured a copy of its estimate or report of losses and, upon the insured’s request, any supporting documentation it sends to the insurer (63 P.S. § 1605(a.2)(3)).

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Within two (2) business days of the execution date of this contract, CLAIM CRUSHERS LLC will notify the insurer of its representation to facilitate the processing of the claim (31 Pa. Code § 115.9 and Department guidance); a signed Notice of Representation is attached for that purpose. CLAIM CRUSHERS LLC will communicate all settlement offers to the insured in writing within five business days and will reply in writing within five business days to written communications from the insurer that require a response. By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s escrow or trust account at a federally insured financial institution. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

Cancellation after the four day cancellation period. The insured may cancel this contract at any time after the cancellation period by written notice delivered as stated in the Notice of Right to Cancel. If the insured cancels after that period, the insured shall pay CLAIM CRUSHERS LLC for its time and expenses incurred through the date of cancellation at the rate of $350.00 per hour or $575.00, whichever is greater, payable from any insurance proceeds recovered on the claim. CLAIM CRUSHERS LLC will not negotiate, transfer, sell, or assign this contract to a finance company or other third party before midnight of the fifth business day following the execution date (31 Pa. Code § 115.3(e)).

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. The insured was verbally informed of the right to cancel at the time of signing and has been furnished a copy of this executed contract (31 Pa. Code § 115.3(a)).

By signing this agreement, the insured acknowledges reading this entire contract, including the Notice of Right to Cancel on the first page, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above. Execution date of this contract (month, day, year):

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the Pennsylvania Insurance Department, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster maintains the surety bond of not less than $20,000 required by Pennsylvania law.

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Pennsylvania, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Pennsylvania: the public adjuster notifies the insurer of its representation within two business days of the execution date of the contract (31 Pa. Code § 115.9(1) and Department guidance).

Public adjuster handling this claim: PA License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s Client Funds escrow or trust account at a federally insured financial institution (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

You, the insured, may cancel this contract at any time within 72 hours after the contract has been signed between the insured and the public adjuster. See attached notice of cancellation form for an explanation of this right.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Minnesota Department of Commerce. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with Minn. Stat. §§ 72B.01 through 72B.14, including § 72B.135. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. Written fee disclosure (Minn. Stat. § 72B.135, subd. 5): the fee charged by CLAIM CRUSHERS LLC is the percentage stated above, and the insured will not be charged any other fee, rebate, or advance; CLAIM CRUSHERS LLC will not advance money to the insured pending settlement where the amount would be included in the final settlement. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by Minn. Stat. § 72B.135, subd. 4 and 5. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

Disclosure of interest in loss proceeds (Minn. Stat. § 72B.135, subd. 5(a)): CLAIM CRUSHERS LLC has no interest in the loss proceeds other than the fee acquired by this employment contract. CLAIM CRUSHERS LLC does not represent an insurance company or an insurance company adjusting firm, and its services are available for a fee to be paid by the client.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) A public adjuster may not initiate contact with a prospective client between the hours of 8 p.m. and 8 a.m., may not advise any person on questions of law, and may not split a fee with or pay any person for a referral (Minn. Stat. § 72B.135, subd. 4).

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. CLAIM CRUSHERS LLC will give the insurer written notice of its representation (a signed Notice of Representation is attached for that purpose). By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf.

Authorization to Endorse on Behalf of Insured. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued on behalf of the insured. This authorization is limited to the endorsement of the check or payment for deposit only into CLAIM CRUSHERS LLC’s escrow or trust account at a federally insured financial institution. The check or payment will be distributed in the percentages or amounts agreed upon in this contract. The insured will be notified of the deposit of funds, and any distribution of such funds to the insured or to CLAIM CRUSHERS LLC will be accompanied by a detailed written breakdown of the funds distributed. Nothing in this contract requires the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. This authorization may be revoked at any time by the insured upon written notice of such revocation to CLAIM CRUSHERS LLC.

Right to cancel; return of payments; emergency services (Minn. Stat. § 72B.135, subd. 1 and 3). The insured has the right to cancel this contract within 72 hours after it has been signed by giving written notice of cancellation to CLAIM CRUSHERS LLC at the address stated in this contract. Notice of cancellation, if given by mail, is effective upon deposit in a mailbox, properly addressed to CLAIM CRUSHERS LLC and postage prepaid, and is sufficient if it indicates by any form of written expression the intention of the insured not to be bound by this contract. Within ten (10) business days after this contract is cancelled, CLAIM CRUSHERS LLC will return to the insured any payments made by the insured and any note or other evidence of indebtedness. If CLAIM CRUSHERS LLC has performed any emergency services (the removal of water, boarding up a building, and reconnecting lights and heat) within the 72 hour period, CLAIM CRUSHERS LLC is entitled to compensation for those services. Two copies of the Notice of Cancellation form are attached and may be detached from this contract.

Cancellation after the 72 hour period. The insured may cancel this contract at any time after the 72 hour period by written notice delivered as stated above. If the insured cancels after that period, the insured shall pay CLAIM CRUSHERS LLC for its time and expenses incurred through the date of cancellation at the rate of $350.00 per hour or $575.00, whichever is greater, payable from any insurance proceeds recovered on the claim.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. This employment contract is valid only if signed by the insured and by the property owner of the property involved, or an authorized agent or representative (Minn. Stat. § 72B.135, subd. 6(b)). CLAIM CRUSHERS LLC will keep the records of this claim for at least five years after the end of the contracted employment period.

By signing this agreement, the insured acknowledges receiving the boldface notice of the right to cancel and the attached Notice of Cancellation form before signing, acknowledges reading this entire contract, and authorizes CLAIM CRUSHERS LLC

to act as the insured’s representative as stated above. Date and time of signing:

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the Minnesota Department of Commerce, that I displayed my license to the insured, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster is bonded as required by Minnesota law.

NOTICE OF CANCELLATION (two copies, detachable, Minn. Stat. § 72B.135, subd. 2(2))

NOTICE OF CANCELLATION Copy 1 of 2 (insured keeps)

(Enter date of contract) If you do not want to go forward with the contract with the public adjuster, you may cancel the contract by mailing or delivering a signed and dated copy of this cancellation notice or any other written notice to CLAIM CRUSHERS LLC, at 9924 Davis St, STE 1, Braselton, GA 30517 (mailing address PO Box 579, Braselton, GA 30517), not later than midnight of (Date). If you cancel, any payments made by you under the contract will be returned within ten business days following receipt by the public adjuster of your cancellation notice.

I HEREBY CANCEL THIS TRANSACTION.

(Date) (Insured’s signature)

NOTICE OF CANCELLATION Copy 2 of 2 (to be returned to the public adjuster if cancelling)

(Enter date of contract)

If you do not want to go forward with the contract with the public adjuster, you may cancel the contract by mailing or delivering a signed and dated copy of this cancellation notice or any other written notice to CLAIM CRUSHERS LLC, at 9924 Davis St, STE 1, Braselton, GA 30517 (mailing address PO Box 579, Braselton, GA 30517), not later than midnight of (Date). If you cancel, any payments made by you under the contract will be returned within ten business days following receipt by the public adjuster of your cancellation notice.

I HEREBY CANCEL THIS TRANSACTION.

(Date) (Insured’s signature)

Cut along the lines to detach a copy. Statements above are printed in boldface type of a minimum size of ten points as required by Minn. Stat. § 72B.135, subd. 2.

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Minnesota, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Minnesota: written notice of the public adjuster’s representation is given to the insurer after the contract is signed.

Public adjuster handling this claim: MN License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s Client Funds escrow or trust account at a federally insured financial institution (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only). Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Indiana Department of Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with Ind. Code § 27-1-27-1 et seq. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services.

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate, confer, and negotiate with the insurer, its adjusters, and its representatives on the insured’s behalf; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

Commencement of services. In accordance with Ind. Code § 27-1-27-13, CLAIM CRUSHERS LLC will not provide services, other than emergency services, to the insured until this contract has been executed and an exact copy of it has been provided (by email or otherwise) to the insurer with which the insured has filed or intends to file the claim, or to the insurer’s representative authorized to receive a notice of loss.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. The exact percentage stated above is the public adjuster’s share of the total amount paid by the insurer to resolve the claim (Ind. Code § 27-1-27-16(c)). If the insurer, not more than five (5) business days after the date on which the loss is reported to the insurer, either pays or commits in writing to pay the policy limit of the insurance policy, CLAIM CRUSHERS LLC will not be compensated by a percentage of the total amount paid by the insurer, will inform the insured that the recovery might not be increased by the insurer, and will be entitled only to reasonable compensation for services provided on the insured’s behalf based on the time spent on the claim and the expenses incurred (Ind. Code § 27-1-27-18). Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees. Initial expenses to be reimbursed to CLAIM CRUSHERS LLC from the proceeds of the claim payment, specified by type with dollar estimates (write NONE if none): . Any additional expense must first be approved by the insured in writing. CLAIM CRUSHERS LLC will not be reimbursed for any expenses other than those specified above unless those expenses are first approved by the insured (Ind. Code § 27-1-27-16(d)).

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by Ind. Code § 27-1-27-12. The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) CLAIM CRUSHERS LLC does not perform the role of roofing contractor, appraiser, or any role other than rendering advice or assistance to the insured in the adjustment of the claim, and this contract does not give CLAIM CRUSHERS LLC a power of attorney to act in the place of the insured.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Upon execution of this contract, CLAIM CRUSHERS LLC will provide an exact copy of it to the insurer (email permitted) and will communicate with the insurer and its representatives on the insured’s behalf, as authorized by the insured’s signature below and the attached Notice of Representation.

Payment of claim proceeds. The insured is not required to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC. At the insured’s option, the insured may ask the insurer to name CLAIM CRUSHERS LLC as a co payee on the insurer’s payment of the claim (Ind. Code § 27-1-27-16(b)). Any funds CLAIM CRUSHERS LLC receives, accepts, or holds on behalf of the insured will be deposited in an escrow or trust account at a federally insured financial institution and distributed in the percentages or amounts agreed upon in this contract, with a detailed written breakdown of the funds distributed provided to the insured.

NOTICE OF RIGHT TO RESCIND (Ind. Code § 27-1-27-20)

You, the insured, may rescind this contract at any time not more than three (3) business days after the day on which you submit to the insurer the claim to which this contract relates. To rescind, notify CLAIM CRUSHERS LLC in writing of your decision by (1) registered or certified mail, return receipt requested, sent to CLAIM CRUSHERS LLC, 9924 Davis St, STE 1, Braselton, GA 30517; (2) personally serving the notice on CLAIM CRUSHERS LLC; or (3) sending an email to admin@crushingclaims.com. If you rescind, CLAIM CRUSHERS LLC will return to you anything of value that you gave under this contract not more than fifteen (15) business days after it receives your notice.

Date the claim was (or will be) submitted to the insurer:

Cancellation after the rescission period. The insured may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the insured cancels after the rescission period, CLAIM CRUSHERS LLC shall be entitled to reasonable compensation for the documented services it performed through the date of cancellation, payable only from money actually paid by the insurer on the claim, not to exceed the percentage stated in this contract applied to those payments.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. Nothing in this contract precludes CLAIM CRUSHERS LLC’s liability to the insured for CLAIM CRUSHERS LLC’s negligence (Ind. Code § 27-1-27-15(a)(4)).

By signing this agreement, the insured acknowledges receipt of the separate signed and dated Disclosure Document before signing, acknowledges reading this entire contract including the right to rescind, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I hold certificates of authority to act as public adjusters issued by the Indiana Department of Insurance, that my full name shown here is as specified in the records of the Department, that the certificate is valid and in full force and effect as of the date of signing, and that the public adjuster is fully bonded under Indiana law (Ind. Code § 27-1-27-16(a)(10)).

DISCLOSURE DOCUMENT (separate, signed and dated, provided before the contract is entered into)

This separate disclosure is provided to the insured before the Public Adjuster Contract is signed, as required by Ind. Code § 27-1-27-14.

“Property insurance policies obligate the insured to present a claim to his or her insurer for the insurer’s consideration. There are three (3) types of adjusters that could be involved in that process. Here are definitions of the three (3) types of adjusters:

“Company adjuster” means an insurance adjuster who is an employee of an insurer, who represents the interests of the insurer, and who is paid by the insurer. A company adjuster will not charge the insured a fee.

“Independent adjuster” means an insurance adjuster who is hired on a contract basis by an insurer to represent the insurer’s interest in the settlement of a claim and who is paid by the insurer. An independent adjuster will not charge the insured a fee.

“Public adjuster” means an insurance adjuster who does not work for any insurer. A public adjuster represents the insured to assist in the preparation, presentation, and settlement of the insured’s claim. The insured hires a public adjuster by signing a contract under which the insured agrees to pay the public adjuster a fee or commission based on a percentage of the amount paid by the insurer in settlement of the insured’s claim or based on some other method of compensation.”

In addition (Ind. Code § 27-1-27-17): (1) An insured is not required to hire a public adjuster to help the insured meet the insured’s obligations under a policy, but has a right to do so. (2) The public adjuster is not a representative or employee of the insurer. (3) The salary, fee, commission, or other consideration to be paid to the public adjuster is the obligation of the insured, not of the insurer, except when the insured has assigned the insured’s rights to the public adjuster.

I/We acknowledge that I/we received and read this disclosure before signing the Public Adjuster Contract with CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): License #: Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Indiana, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Indiana: an exact copy of the executed contract is provided to the insurer (email permitted) before any services other than emergency services are provided (Ind. Code § 27-1-27-13). This letter accompanies that copy.

Public adjuster handling this claim: IN Certificate of Authority #: Office phone:

I/We, the undersigned insured(s), do hereby retain CLAIM CRUSHERS LLC to be my agent and representative to assist in the preparation, presentation, and adjustment of my first party property insurance claim for the loss or damage listed above, including communication with the insurer and its representatives on my behalf and, where applicable, representation on my behalf before the Kentucky Department of Insurance. CLAIM CRUSHERS LLC is hired as a licensed public adjuster and is obligated to serve with objectivity and complete loyalty to the interest of the insured alone and to render to the insured such information, counsel, and service within CLAIM CRUSHERS LLC’s knowledge, understanding, and opinion that will best serve the insured’s insurance claim needs and interest, in accordance with KRS 304.9-430 through 304.9-4335 and 806 KAR 9:400. CLAIM CRUSHERS LLC does not practice law and does not give legal advice, and nothing in this contract is an agreement to provide legal services. CLAIM CRUSHERS LLC shall not give legal advice and shall not act on behalf of or aid any person in negotiating or settling a claim relating to bodily injury, death, or noneconomic damages (KRS 304.9-433(2)(l)).

SERVICES TO BE PROVIDED. CLAIM CRUSHERS LLC will, as applicable to the loss: (1) inspect, photograph, and document the damaged property; (2) review the insurance policy and the claim as presented; (3) prepare an itemized estimate of the loss and, only with the insured’s prior written approval, engage appraisers, engineers, or other experts; (4) prepare, present, and submit the claim and all supporting documentation to the insurer; (5) attend inspections and communicate and confer with the insurer, its adjusters, and its representatives on the insured’s behalf to present, document, and support the claim; however, for the two year period beginning July 15, 2026, CLAIM CRUSHERS LLC shall not negotiate with the insurer on behalf of the insured in the adjustment or settlement of the claim, as required by KRS 304.9-4331(7), and all settlement negotiation and settlement decisions remain with the insured; (6) communicate all settlement offers to the insured in writing promptly so that the insured is aware of all options; and (7) keep a record of the work performed. The duties of the public adjuster are limited to assisting in proving the loss and coverage where applicable under the first named insured’s policy and determining the value of the loss covered by that policy. The insured agrees to assist CLAIM CRUSHERS LLC in the processing of the claim, and all information given by the insured to CLAIM CRUSHERS LLC will be presumed to be true. CLAIM CRUSHERS LLC will not agree to any loss settlement without the insured’s knowledge and consent.

Commencement of services. In accordance with KRS 304.9-433(1), CLAIM CRUSHERS LLC will not provide services to the insured until this contract has been executed on this form, which has been prefiled with and approved by the Commissioner of Insurance, and the rescission period stated below has concluded, except as the Commissioner may permit in emergency circumstances.

The insured agrees to pay CLAIM CRUSHERS LLC for such services a fee of Select10%11%12%13%14%15%16%17%18%19%20%21%22%23%24%25% % (exact percentage) of all insurance proceeds paid by the insurer under the policy for the covered loss after the date of this contract, whether paid to or on behalf of the insured, including amounts applied to and including the deductible. CLAIM CRUSHERS LLC’s fee is due as a percentage of each draft or check only when and as it is actually paid by the insurer; the fee will never be collected on money that is due from the insurer but not yet paid, and CLAIM CRUSHERS LLC will not collect its entire fee from the first check rather than as a percentage of each check. The fee is the obligation of the insured, not the insurer, and is paid by the insured from the sums CLAIM CRUSHERS LLC assists the insured in recovering. In accordance with KRS 304.9-4333, the fee (a) is based only on the amount of insurance settlement proceeds actually received by the insured; (b) will be collected by CLAIM CRUSHERS LLC only after the insured has received the insurance settlement proceeds from the insurer; (c) will not be charged on any proceeds received by the insured before this contract is executed or before the rescission period concludes; and (d) shall not exceed ten percent (10%) of the insurance settlement proceeds upon which a fee may be based. If the insurer pays or commits in writing to pay the policy limit of the insurance policy before this contract is executed or before the rescission period concludes, CLAIM CRUSHERS LLC will not receive a commission consisting of a percentage rate, will inform the insured that the claim settlement amount may not be increased by the insurer, and will be entitled only to reasonable compensation based on the time spent on the claim and the expenses incurred before the claim was paid or the written commitment was received. The rate of compensation will not be increased because a claim is litigated. Expenses may include but are not limited to appraisal fees, engineer fees, satellite imagery costs and/or other related costs. No related expenses or costs will be charged to the insured unless agreed to in writing prior to incurring the associated fees. Initial expenses to be reimbursed to CLAIM CRUSHERS LLC from the proceeds of the claim payment, specified by type with dollar estimates (write NONE if none): . Any additional expense must first be approved by the insured in writing.

Interest Disclosure. The public adjuster does not have any direct or indirect interest in or compensation by any construction firm, salvage firm, building appraisal firm, storage company, motor vehicle repair shop, or any other firm or business entity that provides estimates for work or performs any work in conjunction with damages incident to any loss which the adjuster has been contracted to adjust. The public adjuster does not have any direct or indirect participation in the reconstruction, repair, or restoration of damaged property that is the subject of a claim adjusted by the adjuster, has no financial interest in any salvage of the property, and will not refer the insured to any repair or service provider in which the public adjuster has a financial interest or from which it may receive compensation for the referral, all as prohibited by KRS 304.9-4331(6). The public adjuster does not receive any direct or indirect compensation of value in connection with the insured’s specific loss other than the compensation from the insured for service as a public adjuster stated in this contract. Written disclosure of any such interest, if one exists (write NONE if none):

WE REPRESENT THE INSURED ONLY.

A copy of the written financial interest disclosure above is provided to the insured, to the insurer, and to the Commissioner of Insurance as required by KRS 304.9-4331(5). CLAIM CRUSHERS LLC does not use a contractor, another business, or any other person to solicit or obtain contract signatures and does not use claim information for marketing or other commercial purposes (KRS 304.9-4331(6)).

IMPORTANT DISCLOSURES TO THE INSURED

(1) You are not required to hire a public adjuster to help you meet your obligations under your policy, but you have the right to do so.

(2) You have the right to initiate and maintain direct communications with your attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, or any other person regarding the settlement of your claim, and this contract does not restrict that right or your right to pursue any civil remedy relating to your claim.

(3) CLAIM CRUSHERS LLC is not an agent, representative, or employee of your insurer.

(4) The fee, commission, or other consideration due to CLAIM CRUSHERS LLC is the obligation of the insured, not the insurer, and is paid by the insured from the sums recovered on the claim.

(5) Complaints regarding this contract or regarding the public adjuster may be filed with the consumer protection division of the Kentucky Department of Insurance: Kentucky Department of Insurance, Consumer Protection Division, 500 Mero Street, 2 SE 11, Frankfort, KY 40601; phone 502-564-6034 (toll free in Kentucky 800-595-6053); email DOI.ConsumerComplaints@ky.gov.

(6) Any legal action arising out of or related to this contract shall be heard only in the courts of, and governed only by the laws of, the Commonwealth of Kentucky.

Payment Disclosure. The insured may direct CLAIM CRUSHERS LLC in writing to make disbursements to third party contractor(s) on behalf of the insured from insurance drafts and checks upon receipt of such payments from the insurer for work contracted to be performed or work completed by the contractor related to the claim. If a direction to pay is requested, the insured will remain an endorsee on the draft. CLAIM CRUSHERS LLC does not choose the persons who will perform repair work; that choice belongs to the insured.

Communication with the Insurer. Within seventy two (72) hours of entering into this contract, CLAIM CRUSHERS LLC will provide the insurer (a) a notification letter signed by the insured authorizing CLAIM CRUSHERS LLC to render advice and assistance to the insured in accordance with KRS Chapter 304, Subtitle 9, and (b) a physical copy of this contract (KRS 304.9-433(7)). A signed Notice of Representation is attached for that purpose. By signing this contract the insured authorizes CLAIM CRUSHERS LLC to initiate and maintain communication with the insurer and its representatives on the insured’s behalf once the rescission period has concluded.

Insurer access, inspection, and direct contact (KRS 304.9-4331). CLAIM CRUSHERS LLC will ensure that prompt notice of the claim is provided to the insurer, that the property is made available for the insurer’s inspection of the loss or damage, and that the insurer is given the opportunity to interview the insured directly about the loss and the claim. CLAIM CRUSHERS LLC will not restrict or prevent the insurer, its adjuster, or any attorney, investigator, or other person acting on the insurer’s behalf from having reasonable access, at reasonable times, to the insured or to the insured property, from obtaining information needed to investigate and respond to the claim, or from corresponding directly with the insured, except that CLAIM CRUSHERS LLC shall be copied on any correspondence with the insured relating to the claim. CLAIM CRUSHERS LLC may be present for the insurer’s inspection, but if CLAIM CRUSHERS LLC’s unavailability after a reasonable request by the insurer would delay the insurer’s timely inspection, the insured will allow the insurer access to the property without the participation or presence of CLAIM CRUSHERS LLC.

Funds received on behalf of the insured; Authorization to Endorse. Any funds CLAIM CRUSHERS LLC receives, accepts, or holds on behalf of the insured will be deposited in an escrow or trust account at a federally insured financial institution and will be disbursed to the insured, less only the fee and expenses provided in this contract and only after the insured’s share has been made available to the insured, with a detailed written breakdown of the funds distributed. The insured authorizes CLAIM CRUSHERS LLC to sign or endorse a payment, draft, or check issued to the insured solely for deposit into that account. This contract does not require the insured to authorize the insurer to issue a check only in the name of CLAIM CRUSHERS LLC (KRS 304.9-433(4)(c)). This authorization may be revoked at any time by the insured upon written notice to CLAIM CRUSHERS LLC.

NOTICE OF RIGHT TO RESCIND (KRS 304.9-433(8), (9) and (10))

You, the insured, have the right to rescind this contract within five (5) business days after the date a physical copy of the contract was provided to you. If this contract was entered into based on events that are the subject of a state of emergency declared by the Governor, a local chief executive officer, or a local government under KRS 39A.100 or 39B.070, you have ten (10) days after the contract is executed to rescind. The rescission must be in writing, mailed or delivered to CLAIM CRUSHERS LLC at 9924 Davis St, STE 1, Braselton, GA 30517 (mailed to PO Box 579, Braselton, GA 30517, or emailed to admin@crushingclaims.com), and postmarked or received within the applicable rescission period. CLAIM CRUSHERS LLC may also rescind this contract by written notice delivered to you by the same date. If you rescind, anything of value given by you to CLAIM CRUSHERS LLC under the contract will be returned to you within fifteen (15) business days after CLAIM CRUSHERS LLC receives your rescission notice. A physical copy of this contract is required; an electronic copy does not satisfy that requirement. Date a physical copy of this contract was provided to the insured: Date by which rescission by either party may occur:

Cancellation after the rescission period. The insured may cancel this contract at any time after the rescission period by written notice delivered as stated above. If the insured cancels after the rescission period, CLAIM CRUSHERS LLC shall be entitled to reasonable compensation for the documented services it performed through the date of cancellation, payable only from insurance settlement proceeds actually received by the insured on the claim after the rescission period concluded, collected only after the insured has received those proceeds, and not to exceed ten percent (10%) of those proceeds.

General Terms. This contract is executed in duplicate so that an original is provided to the public adjuster and an original is provided to the insured, and the public adjuster’s original is available at all times for inspection without notice by the insurance regulator. This contract does not impose collection costs or late fees on the insured, does not preclude the insured or the public adjuster from pursuing any civil remedy, and does not increase CLAIM CRUSHERS LLC’s rate of compensation because a claim is litigated. If any provision of this contract conflicts with applicable law, the law controls and the remaining provisions remain in effect. This contract is the entire agreement between the parties regarding the claim described above and may be changed only in a writing signed by both parties. This contract is executed in duplicate and an original physical copy is provided to the insured and to the public adjuster (KRS 304.9-433(6)). Compensation provisions will not be redacted in any copy of this contract provided to the Commissioner. A contract in violation of KRS Chapter 304 is not enforceable.

By signing this agreement, the insured acknowledges receipt of the separate Public Adjuster Disclosure Document before signing, acknowledges reading this entire contract including the right to rescind, and authorizes CLAIM CRUSHERS LLC to act as the insured’s representative as stated above.

Public Adjuster: By signing this contract, I attest that CLAIM CRUSHERS LLC and I are licensed as public adjusters by the Kentucky Department of Insurance, that my full name shown here is as specified in the Department’s licensing records, that the license is valid and in full force and effect as of the date of signing, and that the public adjuster has a letter of credit or a surety bond as required by KRS 304.9-430(3).

PUBLIC ADJUSTER DISCLOSURE DOCUMENT (provided to the insured before signing the contract)

This separate disclosure is provided to the insured before the Public Adjuster Contract is signed, as required by KRS 304.9-433(5).

“Property insurance policies obligate the insured to present a claim to his or her insurance company for consideration. Three (3) types of adjusters may be involved in the claim process as follows:

1. “Staff adjuster” means an insurance adjuster who is an employee of an insurance company, who represents the interest of the insurance company, and who is paid by the insurance company. A staff adjuster shall not charge a fee to the insured;

2. “Independent adjuster” means an insurance adjuster who is hired on a contract basis by an insurance company to represent the insurance company’s interest in the settlement of the claims and who is paid by the insurance company. An independent adjuster shall not charge a fee to the insured; and

3. “Public adjuster” means an insurance adjuster who does not work for any insurance company. A public adjuster works for the insured to assist in the preparation, presentation, and settlement of the claim, and the insured hires a public adjuster by signing a contract agreeing to pay him or her a fee or commission based on a percentage of the settlement or another method of payment.

The insured is not required to hire a public adjuster to help the insured meet his or her obligations under the policy, but has the right to hire a public adjuster. The insured has the right to initiate direct communications with the insured’s attorney, the insurer, the insurer’s adjuster, the insurer’s attorney, and any other person regarding the settlement of the insured’s claim. The public adjuster shall not be a representative or employee of the insurer. The salary, fee, commission, or other consideration paid to the public adjuster is the obligation of the insured, not the insurer.”

I/We acknowledge that I/we received and read this disclosure before signing the Public Adjuster Contract with CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): License #: Date:

NOTICE OF INSURED’S RIGHTS (KRS 304.9-4331(1); rights under KRS 304.9-433, 304.9-4331 and 304.9-4332)

1. You are not required to hire a public adjuster to meet your obligations under your policy, but you have the right to do so. CLAIM CRUSHERS LLC is not a representative or employee of your insurer, and its fee is your obligation, not the insurer’s (KRS 304.9-433(5)).

2. You may rescind the Public Adjuster Contract within five (5) business days after a physical copy is provided to you, or within ten (10) days after execution if the contract relates to a declared state of emergency, by written notice mailed or delivered to CLAIM CRUSHERS LLC and postmarked or received within that period; anything of value you gave will be returned within fifteen (15) business days. No services will be provided until the contract is executed on a form approved by the Commissioner and the rescission period has concluded (KRS 304.9-433(1), (8), (9)).

3. You are entitled to a physical original copy of the contract; an electronic copy does not satisfy that requirement (KRS 304.9-433(6), (10)).

4. You have the right to communicate directly with your insurer, its adjuster, its attorney, your own attorney, and any other person about the settlement of your claim, and your insurer has the right to correspond directly with you, with CLAIM CRUSHERS LLC copied on that correspondence (KRS 304.9-433(5); 304.9-4331(3)).

5. Your insurer is entitled to prompt notice of the claim, to reasonable access at reasonable times to you and to the insured property, to inspect the loss, and to interview you directly about the loss and the claim. If CLAIM CRUSHERS LLC is unavailable after a reasonable request by the insurer, you must allow the insurer to inspect the property without CLAIM CRUSHERS LLC present (KRS 304.9-4331(2) to (4)).

6. You will receive a written disclosure of any direct or indirect financial interest CLAIM CRUSHERS LLC has with any other party involved in your claim; the same disclosure is given to your insurer and to the Commissioner (KRS 304.9-4331(5)). CLAIM CRUSHERS LLC may not participate in the repair or restoration of your property, may not have a financial interest in any salvage, repair, or other business that obtains work from your claim, and may not use your claim information for marketing (KRS 304.9-4331(6)).

7. For the two year period beginning July 15, 2026, a public adjuster may not negotiate with your insurer on your behalf in the adjustment or settlement of your claim (KRS 304.9-4331(7)). CLAIM CRUSHERS LLC will document, prepare, present, and support your claim and will advise you, but settlement negotiations and settlement decisions remain yours.

8. The fee may not exceed ten percent (10%) of the insurance settlement proceeds on which a fee may be based, is based only on proceeds you actually receive after the contract is executed and the rescission period ends, and is collected only after you receive those proceeds (KRS 304.9-4333). No fee is charged on money that is due from the insurer but not yet paid, and the entire fee is never taken from the first check (KRS 304.9-433(4)).

9. Any funds CLAIM CRUSHERS LLC receives, accepts, or holds on your behalf remain your property, will be deposited in a federally insured escrow or trust account, and will be disbursed to you with a written breakdown as required by KRS 304.9-4332 and this contract.

10. Complaints regarding this contract or regarding the public adjuster may be filed with the Consumer Protection Division of the Kentucky Department of Insurance, 500 Mero Street, 2 SE 11, Frankfort, KY 40601; 502-564-6034 (toll free 800-595-6053); DOI.ConsumerComplaints@ky.gov.

I/We acknowledge receiving this written notice of my/our rights from CLAIM CRUSHERS LLC.

Provided by (public adjuster printed name and signature): KY License #: Date:

NOTICE OF REPRESENTATION AND AUTHORIZATION TO COMMUNICATE

To whom it may concern:

I/We, the undersigned insured(s), have retained CLAIM CRUSHERS LLC, a public adjuster licensed in the State of Kentucky, to represent my/our interests in the preparation, presentation, and adjustment of the first party property insurance claim identified above. I/We hereby authorize CLAIM CRUSHERS LLC to initiate and maintain direct communication with you, your adjusters, your independent adjusters, and your attorneys on my/our behalf regarding this claim; to receive copies of all correspondence, estimates, coverage positions, and payment information relating to this claim; and to attend all inspections of the property.

This authorization does not restrict my/our right to communicate directly with you or with any other person regarding this claim, and you retain the right to communicate directly with me/us. Please send copies of all claim correspondence to CLAIM CRUSHERS LLC at 9924 Davis St Ste 1, Braselton, GA 30517, by mail to PO Box 579, Braselton, GA 30517, by email to office@crushingclaims.com, or by telephone at (706) 471-1407.

Kentucky: this signed notification letter and a physical copy of the contract are provided to the insurer within 72 hours of entering into the contract (KRS 304.9-433(7)). Financial interest disclosure to the insurer under KRS 304.9-4331(5): the public adjuster has no direct or indirect financial interest with any other party involved in any aspect of this claim except as stated here (write NONE if none): . For the two year period beginning July 15, 2026, the public adjuster will not negotiate with you on the insured’s behalf in the adjustment or settlement of the claim (KRS 304.9-4331(7)); settlement decisions remain with the insured.

Public adjuster handling this claim: KY License #: Office phone: (706) 471-1407

LIMITED POWER OF ATTORNEY (Endorsement of Insurance Proceeds Checks)

(“Principal”) does hereby make, constitute and appoint Claim Crushers, LLC (“Attorney in Fact”), whose address is 9924 Davis St, STE 1, Braselton, GA 30517, to be its true and lawful attorney in fact, in its place and in its stead, for the limited purpose of endorsing insurance proceeds checks made payable to Principal, and possibly to other parties, so that those checks may be deposited to Claim Crushers, LLC’s Client Funds escrow or trust account at a federally insured financial institution (for checks that include any money owed to the client) or Operating Account (for checks that are for public adjuster’s fees and costs only), with the public adjuster’s fee collected only after the insured has received the insured’s share of the proceeds in accordance with KRS 304.9-4333. Any act, contract, agreement, writing or thing which shall be done, given, delivered, executed, or said by Claim Crushers, LLC pursuant to this Power of Attorney for the purpose noted above shall be as good, valid, and effectual as if they had been done, given, delivered, executed, or said by Principal, and Principal does hereby undertake and agree at all times to ratify whatever its Attorney in Fact may lawfully do or cause to be done in or concerning the endorsement of insurance proceeds checks. Principal hereby authorizes its Attorney in Fact and Claim Crushers, LLC to rely upon and act in accordance with this Power of Attorney and hereby indemnifies and holds harmless Attorney in Fact and Claim Crushers, LLC in connection with any action that they may take in reliance on or in connection with this Power of Attorney.

This Power of Attorney is limited to the endorsement of insurance proceeds checks for deposit as stated above. It does not give Claim Crushers, LLC authority to settle the claim without Principal’s consent, to choose the persons who will perform repair work, or to act in the place of Principal for any other purpose, and it may be revoked by Principal at any time by written notice to Claim Crushers, LLC.