Customer Communication and Work Authorization

This authorization is made this March 4, 2024 b​y ​ and between Restoration Doctor LLC,​ hereinafter referred to as ​Restoration Doctor​ and hereinafter referred to as the Client. The Client authorizes Restoration Doctor to proceed with its recommended procedures to preserve, protect and secure from further damage the property located at: Providing the Client has valid effective insurance coverage for all or part of the services to be performed by Restoration Doctor, the Client further authorizes and directs their insurance carrier to pay Restoration Doctor directly, and to name Restoration Doctor on any and all insurance drafts applicable to this loss.

Effect of Abnormal Water: ​Water indoors is an abnormal condition and can cause or contribute to a number of problems. The damage and health implications increase the longer materials remain wet. T​here are at least four progressive stages of indoor water damage.

1.​ W​ater migrates into areas not originally affected. Water spreads laterally into adjoining rooms, penetrates materials below and wicks up into porous materials above. It is best to evaluate all affected areas, not just areas with visible saturation.

2. Saturated materials begin swelling as they absorb moisture. In many situations, drying and restoration will restore them, and in others, the damage may be permanent. Rapid drying will help reduce the chance of permanent damage.

3. As water evaporates it causes an abnormal humidity condition. High humidity can damage some porous materials if allowed to continue. Humidity damage is most common when the indoor humidity exceeds 60% over time. It is best to reduce indoor humidity quickly to help prevent humidity damage.

4. After water intrusion, mold and bacterial spores can germinate and multiply. Microorganisms can cause mold damage and degrade indoor air quality. Some microorganisms produce antigens and allergens, which cause allergies while others can cause infections and toxic diseases.

Reducing Mildew Growth & Damage: ​I understand that several things that can be done to help reduce mold growth and damage to affected materials: (1) Water can be removed; (2) Antimicrobial agents can be applied to help inhibit the growth of mold and other bio-contaminants; (3) Rapid air movement can be introduced into areas and cavities to increase the rate of evaporation; and (4) Relative humidity (RH) indoors can be reduced. I further understand, that Restoration Doctor, (1) Is not a mold remediation company; (2) Does not guarantee or warranty whatsoever that it can identify or remove mold; (3) That a company possessing expertise in mold remediation must be hired to help ensure proper identification and removal of mold and mildew; and (4) Restoration Doctor’s services may only help, not prevent or resolve, any issues related to mold and mildew.


Authorization: ​I the Owner/Agent for the job site listed below, authorize Restoration Doctor to enter my property, furnish materials, supply all equipment and perform all labor necessary to preserve and protect my property from further damage, and to perform all restoration procedures necessary to repair and restore the carpet, furniture, structure and other furnishings.


Prices: ​I understand that water damage is a progressive condition and that drying time varies depending on the types of materials, the quantity of water, degree of saturation, airflow volume and velocity, temperature, and the indoor and outdoor humidity. Therefore, I understand it is impractical to give an accurate quote for services before completion. I agree to pay the full price for the work Restoration Doctor performs.


Stop Work-Hold Harmless: I​n the event that Restoration Doctor is not allowed to perform its recommended procedures and/or drying equipment is removed prematurely, I agree to release and hold Restoration Doctor harmless, and indemnify Restoration Doctor and all of Restoration Doctor’s subsidiaries and sub-contractors against any claims, actions, and liabilities that may result from such incomplete procedures.


Authorize Antimicrobials Agents: ​I understand that in the best judgment of Restoration Doctor all wet materials should be treated with a commercial antimicrobial agent to help inhibit the growth of microorganisms during the drying process. I agree that all wet materials should be treated with the antimicrobial agent as part of the mitigation & restoration process. I understand that Restoration Doctor’s services do not include mold inspections or mold removal, and I, therefore, agree to release, agree to indemnify and hold Restoration Doctor harmless for any biological odors or growth, indoor air quality degradation and any mold-related personal injuries or other damages to health that may occur due to microbiological activity during and/or after the mitigation process.


Safety: I​ f dehumidifiers or air movers must be moved, they must be shut off and unplugged, as it may be hazardous to move these units while they are operating. Exposed tackless strips are a danger even when covered; I will take care when walking near a tackless strip. The floors may be slippery when wet; I will take extreme care if walking on or from wet flooring materials.


Equipment Responsibility: I​ understand that I am personally responsible for any damage, loss or theft of drying equipment while in my care and custody, and will take reasonable precautions to ensure that this drying equipment is not lost, stolen or damaged.


Merger Clause:​ This work authorization contains the final, complete and exclusive statement of the agreement between Restoration Doctor and Client with respect to the transactions contemplated herein. All other prior or contemporaneous oral communications (including, for the avoidance of doubt, any communications in connection with the preparation of this work authorization), and all prior written or oral communications and agreements, with respect to the subject matter hereof are merged herein and superseded into this work authorization. For the avoidance of doubt, it is the parties’ intent that no term contained in or omitted from any prior written draft of this work authorization or other communication be used as extrinsic evidence under any state law or judicial interpretation to determine the intent of the parties hereto.


Insurance Payments: I​ f the insurance company makes payment directly to the Owner/Agent, it shall be endorsed over to Restoration Doctor within three (3) working days. I understand that I am personally responsible for any and all work performed by Restoration Doctor, Restoration Doctor’s subsidiaries, and Restoration Doctor’s sub-contractors, regardless of whether my insurance company covers the loss or not. Any and all charges for services not reimbursed by an insurance company are due upon completion of the work.


Other: A​s Owner/Agent of the property, it is understood that I have authorized the work and accept responsibility to Restoration Doctor for services rendered. It is fully understood and agreed that the Owner/Agent is personally responsible for the full costs and charges for the work, including but not limited to any deductible, depreciation or holdback not covered by insurance. Restoration Doctor shall bill all charges and/or costs directly to the Client (insured), and, as a courtesy only, a copy of these documents will be e-mailed to the insurance carrier. It is fully understood and agreed to by the Client that Restoration Doctor is hired directly by the client and is in no way required to deal with or negotiate with the Client’s Insurance company or to provide public adjusting services, and that any and all charges and costs are due upon completion of work. It is fully understood that the Client is personally responsible for any and all deductible, depreciation, holdback, and any charges or costs not covered by insurance. Any and all charges for services not reimbursed by an insurance carrier are the sole responsibility of the Client and are to be paid upon completion of work. Any exceptions must be approved by Restoration Doctor in writing, and a finance charge of 1.5% per month (minimum of $1.00), will be applied to any unpaid balance after thirty (30) days.


Restoration Doctor shall provide all documents pertaining to the project (pictures, dry-logs, invoice) to the Client directly. If the insurance carrier requires any additional documentation it has fifteen (15) days from the date of completion to make such a request. At no time will Restoration Doctor accept a Third Party Assessment of the loss post-mitigation. That includes any Insurance Company Third-Party Vendor or Third-Party Estimate, for work performed by Restoration Doctor or Restoration Doctor’s employees or contractors. Restoration Doctor shall not be responsible for the mysterious disappearance of or damage to any personal property, contents, or building materials. In the event any legal proceedings must be instituted to recover the amount due, Restoration Doctor shall be entitled to recover the cost of collection including reasonable attorney’s fees. This agreement and the rights and obligations of the parties under it are governed by and interpreted in accordance with the laws of the Commonwealth of Virginia (without regard to principles of conflicts of law.) Client consents to the jurisdiction of the Commonwealth of Virginia and the Venue of Fairfax County, Virginia for any litigation regarding this agreement.


  I have read and understood the information above, and have received a copy for my records.


Full Name:



Insurance Company:

Claim No.:

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Signed by Shoghi Darakhshan
Signed On: January 24, 2022

Signature Certificate
Document name: Customer Communication and Work Authorization
lock iconUnique Document ID: e9bfc64d45b41e2ca54a85c91e497b91b3583c67
Timestamp Audit
February 19, 2021 5:04 pm ESTCustomer Communication and Work Authorization Uploaded by Shoghi Darakhshan - [email protected] IP