Claims Management Specialists and/or any of the listed licensed representatives (hereinafter “Adjuster”) are hereby retained by first last (hereinafter “Insured”), located at street city South Carolina 09809 Insured by company (hereinafter “Insurer”) Policy # policy to assist in the preparation, presentation, and adjusting of the insurance claim arising due to losses sustained to damage (Damaged Areas), caused by Wind/Hail which occurred on or about 04/16/2021. Claim number to be obtained upon filing of claim (intentionally left blank).

Description of Services:
Adjuster duties include but are not limited to documenting or obtaining documentation that may include satellite imagery, weather conditions surrounding the loss, photos of damage, communications with insurance company and negotiating a fair and reasonable cost to replace or repair damaged areas.

Authorization: Insured(s) authorizes and instructs the Insurer to recognize the Adjuster as a party in interest and to supply the Adjuster with all relevant information regarding claim procedures, policy requirements, Insurer’s method of valuation, a complete copy of the insurance policy and any other information that may be needed to properly adjust the claim, as well as assign all payment(s) jointly to both the Adjuster and the insured. All documentation and payment(s) shall be mailed to the Adjuster at 10187 Cherokee Ln, Aurora, IN 47001 Suite 2. Insured authorizes Adjuster to honor and deduct any claim related expenses, invoices, or contracts signed or authorized by the Insured from the insurance proceeds to issue payment directly to the requesting party to fulfill said obligations. Insured(s) agrees to cooperate with, and provide all information and documentation to Adjuster that may be needed to prepare and adjust the claim.

Compensation: Insured(s) agrees to compensate the Adjuster 10% (Ten Percent) of the total settlement amount paid by the insurer(s), this includes payments made by the insurer(s) in or for partial resolution of the claims, including payments made by agreement, court judgment, mediation, arbitration, appraisal, and any other forms of dispute resolution. Insured also agrees to a $150.00 reporting fee to cover detailed weather reports and/or satellite roof measurements in addition to the compensation. If the insurer pays or commits in writing to pay the policy limits to the insured within 72 hours of the loss being reported the Adjuster compensation shall be reduced to a $750.00 (Seven Hundred and Fifty Dollar) flat fee in addition to the reporting fee for a total expense of $900.00 (Nine Hundred Dollars) plus any charges with prior approval.

Surety Bond: Adjuster is bonded in the amount of $20,000.00 (Twenty Thousand Dollars) as required by Kentucky code KRS 304.9-430(3). Provided upon request.

Disclosure: Claims Management Specialists is owned by Christopher A. Schwab. Mr. Schwab also owns Over The Top Roofing & Remodeling, which may be the contractor chosen by the insured under a separate contract to perform all or part of the repairs listed on the Insurer scope of work as a result of the claim included in this Public Adjuster contract. Mr. Schwab formed Claims Management Specialists to better serve his customers and to aide others with the claims process.

Confirmation: Insured(s) confirm receipt and understanding of claims process disclosure prior to signing this contract.

Right of Rescission: The insured has the right to rescind the contract within three (3) business days after the date the contract was signed. The rescission shall be in righting and mailed or delivered to the Adjuster at the address in the contract and postmarked or received within the three (3) business day period. If the right to rescind is exercised the Adjuster shall return anything of value within 15 business days following the receipt of the rescission notice. See attached notice of cancellation form.

SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69c426002.78769121&form-id=2&field-id=13&hash=96de863e8a348c15af5d508a05dfd63adae4850050928afc58756db94542cc6d DATE: 04/16/2021
SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69c4a1ad1.87277988&form-id=2&field-id=15&hash=842a6b86502b8c7907419c2d986c38b754a49c48c40fab29612bf6172952c7e6 DATE: 04/16/2021




If you are notified by your insurance company that all or any part of the claim or contract is not a covered loss under the insurance policy, you may cancel the contract by mailing or delivering a signed and dated copy of this cancellation notice or any other written notice to:

Claims Management Specialist
10187 Cherokee Ln Suite 2
Aurora, IN 47001
(513) 428-8135

At any time before midnight on the third business day after you have received such notice from your insurance company.

If you cancel the contract, any payments made by you under the contract will be returned to you within Fifteen (15) business days following receipt by Claims Management Specialists of your cancellation notice.



DATE 04/16/2021


SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69c4bae28.93047409&form-id=2&field-id=41&hash=e66952c3ac04da4b742763da4821b8d9669dbf1bd0a53d5b57d2fb14e3856880 DATE: 04/16/2021


Claims Management Specialists
Kami L Hamilton, Certified Public Adjuster
License # 3633102
Email: kami@myclaimdamage.com
(513) 428-8135

License # 3637990
10187 Cherokee Ln Suite # 2
Aurora, IN 47001
(513) 428-8135
Email: claims@myclaimdamage.com
Website: myclaimdamage.com

Kami L Hamilton, Certified Public Adjuster
License # 3633102
Email: kami@myclaimdamage.com
(513) 428-8135

Attention Claims Department:

Please be advised that the insured(s), first last, located at street city Kansas 65445 Policy # policy have retained Claims Management Specialists and/or it’s representatives to represent them for the loss occurring on or about 04/16/2021. As stated in the Public Adjuster Contract and at the direction of the insured(s) all further communication shall be directed to the Public Adjuster with all documentation and payments being mailed directly to the Public Adjuster at the address listed above. All payments are to be assigned jointly to both the insured(s) and Claims Management Specialists and mailed to Claims Management Specialists as stated in the contract. Please contact us at your earliest convenience to schedule the initial inspection of the damages.

Thank you in advance for your cooperation.


Claims Management Specialist


I first LAST
authorized and direct my mortgage holder company to release any and all funds received to Claims Management Specialists LLC. for the insurance claim recently filed. Furthermore, it is at my instruction that any form of payment or documentation containing my signature received by my Mortgage Company shall not be changed, discarded, Endorsement Cancelation or otherwise altered in any way that is not an endorsement of payment by my mortgage company. Any documentation received by my mortgage company that contains a “Return Envelope” shall be returned in said envelope to the address listed in the postage column Sender/Receiver or to Claims Management Specialists 10187 Cherokee Ln Aurora, IN 47001 Suite 2.

ADDRESS street
CITY city
STATE Kansas
ZIP 65445
ACCT# #234234234
LAST 4 OF SOCIAL *** 3444
CHECK# 2344
AMOUNT $ 2344

SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69c4d4c58.34453670&form-id=2&field-id=61&hash=9837b1198858e6873493f1f1f9f408f968f477bfc131b32b0b4d0ae35475c52f

SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69e53c820.93261834&form-id=2&field-id=71&hash=f7d654c5b2d0a719bac1605eca4d0a551be9c91b43a3c02379e04ceb759f825d


I/We (Insured) first last, Address street city South Carolina 65443, Phone # (555) 555-5555, last 4 of social security # *** 1223. Do hereby authorize Claims Management Specialists LLC or it’s licensed representatives to Endorse check(s) issued by company (Insurer) made payable to the insured and possibly other parties as a result of the claim under policy # policy, filed on or about 04/16/2021 so that those checks may be deposited into Claims Management Specialists’ Client Funds Account (for checks that include any money owed to client) or Operating Account (for checks that are for public adjuster’s fees or other contracted work pertaining to stated claim). This authorization shall expire 24 months after the claim filing date listed above and is limited to check(s) related to claim(s) for the policy listed above. Insured does hereby undertake and agree at all times to ratify, whatever Claims Management Specialists and its licensed representatives may lawfully do or cause to be done in or concerning the endorsement of the insurance proceeds checks. Insured hereby authorizes Friendship State Bank, the Insurer, and the bank in which payment is issued upon to rely upon and act in accordance with this Authorization and hereby indemnifies and holds harmless Claims Management Specialists, it’s licensed representatives, the Insurer, the issuing bank, and Friendship State Bank in connection with any action that they may take in reliance or in connection with this signature authorization.

SIGNATURE https://myclaimdamage.com/index.php?gf-signature=6079b69e524026.18525621&form-id=2&field-id=70&hash=3e95f9db6ee3e730b16873ce404f1e4c2110fbb7837f4f1afa6b0a2908f1ebf7

SIGNATURE https://myclaimdamage.com/index.php?gf-signature=6079b69e53c820.93261834&form-id=2&field-id=71&hash=f7d654c5b2d0a719bac1605eca4d0a551be9c91b43a3c02379e04ceb759f825d


I first last (Insured) authorize Claims Management Specialist (Adjuster) to deduct the necessary amounts from the proceeds issued by company (Insurer) plus the deductible to honor and make payment directly to any engineer, appraiser, general contractor, contractor, attorney, or mediator for any contract, estimate, invoice, or expense that I/We (Insured) signed or otherwise incurred and authorized. Adjuster compensation shall be deducted from the deductible and total proceeds released by the Insurer prior to the distribution of any funds that may be owed due to other contractual obligations, I/We (Insured) understand that I/We (Insured) are personally responsible to make payment directly to the party owed for any expenses that exceed the funds available and that the Adjuster is in no way liable for any expense incurred. Any proceeds that may be remaining after all authorized financial obligations that have been presented to the Adjuster have been fulfilled shall be returned to the insured within forty-five (45) days of project completion.

SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69e554f20.01743825&form-id=2&field-id=75&hash=3473a99d0eabcb7b39bc97d9fdac7331cac946d8070d631e616ab9c4017c3e90
DATE: 04/16/2021

SIGNATURE: https://myclaimdamage.com/index.php?gf-signature=6079b69e56ca81.41546046&form-id=2&field-id=76&hash=b69867d5dfab3c4f334cae909535fe1e642ff3563b2f12b529b80446a7d3a39b
DATE: 04/16/2021

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