Insurance Restoration Waiver

INSURANCE RESTORATION WAIVER

Insured and Policy Information

Policy Number:     Policy Type:

Policy Period From: to     Deductible: $

Claim and Loss Details

Claim Number:     Date of Loss:

Restoration Election and Acknowledgements

The Insured hereby elects (select one):
Direct payment to contractor/vendor for restoration work
Cash settlement to Insured in lieu of insured-managed restoration
Insurer-managed restoration (standard claim handling continues)

If electing direct payment to contractor, provide contractor details:

Insured acknowledges and agrees to the following substantive terms:

1. Release of Supervision: By electing direct payment or cash settlement, the Insured releases the Insurer from the obligation to supervise, direct, or guarantee the performance, quality, or scheduling of restoration work performed by any contractor retained by the Insured. The Insurer's payment shall not be construed as acceptance of workmanship or as a warranty of repair.

2. Finality of Settlement: Acceptance of payment by the Insured or by the Insured's contractor for the covered loss described above shall operate as a final settlement of the Insurer's obligations for the specific covered loss, except as otherwise required by policy terms or written agreement expressly signed by an authorized Insurer representative.

3. Indemnity: The Insured agrees to indemnify and hold harmless the Insurer from any claims, liens, or causes of action arising out of or related to services, workmanship, or claims by third-party contractors retained by the Insured for restoration, including claims for unpaid labor or materials, unless such claims arise solely from bad faith by the Insurer.

4. Building Codes and Upgrades: Payments made under this waiver are for restoration to the condition covered by the policy. Any costs related to voluntary upgrades, betterments, or building code upgrades not required by applicable law are the responsibility of the Insured unless expressly approved in writing by the Insurer.

Coverage Sections — Affected Coverages

Select coverages implicated by this restoration: (check all that apply)

Exclusions and Limitations

This Waiver does not apply to claims arising from:

- Fraudulent or intentionally caused loss; any losses where coverage is excluded by the policy; any future, unrelated events; or costs beyond the scope of the estimate approved by the Insurer unless amended in writing. The Insurer's obligation remains limited to covered loss as defined by the policy contract.

Mortgagee / Interested Party

If there is a mortgagee, lienholder, or other interested party with a recorded interest in the insured property, enter information below. The execution of this Waiver does not release any mortgagee of its rights under the policy unless the mortgagee executes a separate release.

Documentation Checklist

Check items provided with this Waiver (attach copies):

Insured Certification and Release

By signing below, the Insured certifies under penalty of perjury that the information provided herein is true and correct to the best of the Insured's knowledge. The Insured warrants that they have authority to make the election selected above and to enter into this Waiver. The Insured further acknowledges that they have read and understand all provisions of this Waiver, including the Release of Supervision, Finality of Settlement, Indemnity, and Exclusions, and that execution of this document is voluntary.

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