ClaimsPRO USA Florida LOR

All-Line Public Insurance Adjusters. Florida Licensed and Bonded

AGREEMENT FOR INSURANCE CLAIM REPRESENTATION

I / We , hereby retain CLAIMSPRO U.S.A., to be my / our representative to evaluate, advise, appraise and assistin the adjustment of the loss caused by , on or about , Located at . This agreement is for the insurance policy issued bypolicy #

It is hereby agreed that CLAIMSPRO U.S.A. will be compensated % ( ) of all the funds recovered from the above date loss, regardless of whether the settlement is reached by adjusting, appraisal, mediation or otherwise. The named insured is responsible for payment to CLAIMSPRO U.S.A. within seven (7) days of receiving payment(s) issued from the insurance carrier. Payment is due to CLAIMSPRO U.S.A. regardless of whether we are named payee on the insurance payment(s)issued for the abovementioned claim. If applicable, the insured shall be liable for any additional expense which may include but not limited to engineering fees, outside appraiser fees, umpire fees. Any additional cost will be discussed with the insured prior to being incurred.

CLAIMSPRO U.S.A. and its agents agree to discuss any, and all settlement offers from the carrier with the policy holder before a final settlement is accepted. The policy holder authorizes the carrier to include the name CLAIMSPRO U.S.A. on any/and all drafts related to the above loss.

The right to cancel this contract is reserved by the policy holder for 3 days. Written notice of the cancellation must be post marked within the above time frame, and mailed to CLAIMSPRO U.S.A. via Certified Mail, return receipt requested, or other form of mail which provides proof thereof to the below mentioned address.




  • Pursuant to s. 817.234, Florida Statutes, any person who, with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost of repair of damaged property in support of claim under an insurance policy knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete, or misleading information concerning any fact or thing material to the claim commits a felony of the third degree, punishable as provided in s. 775.082, 1 s. 775.083, or s. 775.084, Florida Statutes.” Jean Chouinard P175691 CLAIMSPRO U.S.A. 2730 13TH Street, St. Cloud Fl. 34769 Phone: 833-252-4601 Fax: 407-593-1686 www.claimsprousa.com