Insurance Mold Test Contract

INSURANCE MOLD TEST CONTRACT

This Insurance Mold Test Contract (the Agreement) is entered into by and between the parties identified below for the performance of environmental mold testing and related reporting services. Client Name: Testing Provider:

INSURED / APPLICANT INFORMATION

Date of Birth: Primary Contact Phone: Email:

POLICY AND CLAIM REFERENCE

Policy Number: Policy Type:

Deductible: Premium: Policy Period From: To:

SCOPE OF TESTING SERVICES

The Provider will perform mold investigation and testing services as selected below at the Insured property located at:

Select tests to be performed (check all that apply):

Air sampling (viable and/or spore trap)    Surface tape/lift sampling    Bulk material sampling

HVAC duct sampling    Hidden cavity inspection (moisture meter/borescope)    Other:

INCIDENT / LOSS DETAILS

Date of discovery of suspected mold or water intrusion:

Estimated visible damage/deterioration:

Documentation provided with this request (check all that apply):

Photographs    Prior inspection reports    Contractor remediation estimates

SAMPLING, ANALYSIS, AND REPORTING

Provider will collect samples in accordance with accepted industry protocols, maintain chain of custody, and submit samples to accredited laboratories where required. Number of air samples to be collected: Number of surface samples:

Spore trap analysis    Viable culture analysis    Species-level identification

FEES, PAYMENT, AND CANCELLATION

Estimated fee for contracted services: Deposit required:

Payment terms: Provider will invoice the Insured or payor designated by the Insured and payment is due within the period stated on the invoice. Cancellation or rescheduling less than 48 hours before scheduled fieldwork may incur a cancellation fee equal to the deposit or greater where laboratory preparations have been initiated.

LIMITATIONS, EXCLUSIONS, AND LIABILITY

The services performed are limited to visual inspection and sampling as expressly selected herein. Provider does not perform remediation or guarantee the absence of mold following testing. Provider's liability for claims arising out of performance or non-performance of these services, whether in contract, tort or otherwise, shall be limited to direct damages not to exceed the total fees paid to Provider under this Agreement. Provider shall not be liable for consequential, incidental, special, or punitive damages. This Agreement does not alter or expand any insurance coverage unless expressly agreed in writing by the Insurer.

EXCLUSIONS

Excluded services include destructive testing beyond sample removal, full-building HVAC system disassembly, legal determinations of habitability, and any tasks requiring licensed remediation contractors unless separately contracted. Conditions concealed behind finished surfaces that are not accessible without demolition are excluded unless prior written authorization is provided.

BENEFICIARY / CLAIM CONTACT

Beneficiary/Claim Contact Name:

Relationship to Insured: Contact Phone:

CERTIFICATION AND AUTHORIZATION

The Insured certifies that the information provided in this Contract is true and correct to the best of the Insured's knowledge. The Insured authorizes Provider to access the property for the purpose of conducting the agreed testing and to collect and transport samples for laboratory analysis. The Insured authorizes Provider to release test results and the final report to the Insured, the Insured's insurance representative, and any authorized third parties designated in writing. The Insured agrees to indemnify and hold Provider harmless from claims arising from inaccurate information provided by the Insured or third-party interference with the testing process.

DISPUTE RESOLUTION

Any dispute arising under this Agreement that cannot be resolved by negotiation shall be submitted to binding arbitration administered in accordance with the rules mutually agreed upon at the time of dispute. The prevailing party in any dispute shall be entitled to recover reasonable attorneys' fees and costs to the extent permitted by applicable law.

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