All-Line Public Insurance Adjusters. Texas Licensed and Bonded

AGREEMENT FOR INSURANCE CLAIM REPRESENTATION

Agent's License Number:
Company License Number:
Date:

This contract form; FIN 535, Public Insurance Adjuster Contract, is prescribed by the Texas Department of Insurance to satisfy contract requirements for Public Insurance Adjusters under amended rules, effective January 1, 2014 for 28 TAC $19.701, 19.708 and 19.713 concerning the licensing of Public Insurance Adjusters.

Insurance Company:
Policy / Claim Number
I / We , hereby retain CLAIMSPRO U.S.A., to be my / our representative to evaluate, advise, appraise and assist in the adjustment of the loss caused by , on or about
, Located at . This agreement is for the insurance policy issued by policy # .

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 above-mentioned 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. If the insurance carrier pays or commits in writing to pay to the insured the policy limits of the insurance policy under Insurance Code Article 6.13 or §862.053 within 72 hours of the loss being reported to the insurer, the public insurance adjuster is not entitled to compensation based on percentage of the insurance settlement,but is entitled to reasonable compensation for the public insurance adjuster’s time and expenses provided to the insured before the claim was paid or the written commitment to pay was received.

IMPORTANT NOTICE: You may contact the Texas Department of Insurance to get information about public insurance adjusters, your rights as a consumer, or information about how to file a complaint by calling 1-800- 252-3439: or you may write the Texas Department of Insurance at PO Box 149104, Austin, Texas 78714-9104, or contact the department via fax 512-490-1007

ADVISO IMPORTANTE: Puede communicarse con el Departamento de Seguros de Texas para obtener informacion acera ajustadores publicos de seguros, sus derechos como consumidor, o informacion sabre como presenter una queja llamando 1-800-252-3439: o puede escribir al Departamento de Seguros de Texas, en PO Box 149104, Austin Texas 78714-9104, o commiquese con el departamento a troves de Fax 512-490-1007.



  • 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
    Agent's License Number:
    Company License Number:
    Date:

    • INSURED/POLICYHOLDER
    • PUBLIC INSURANCE ADJUSTER







    If this contract is negotiated by a Texas nonresident Public Insurance Adjuster, the following Agent for Service of Process must be completed.

    Agent for Service of Process

    Each Texas Nonresident Public Insurance Adjuster license holder shall maintain an agent for service of process in the State of Texas as required in Texas Insurance Code, §4102.107.

    Texas Department of Insurance | www.tdi.texas.govTexas Department of Insurance | www.tdi.texas.gov

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