Umpire Engagement Confirmation Form

The information you provide will help me to understand the extent of the appraiser's differences

and help me set appropriate retainer fees for the parties.

Appraiser's First Name *

Appraiser's Last Name *

Appraiser's Email *

Phone *

Company Name

Carrier name *

Insured Name(s) *

Claim Number *

Please provide the claim number associated with your property damage.

Type of Damage *

Hail
Hail & Wind
Hail & Wind & Water Intrusion
Fire & Smoke
Smoke
Ice Dam
Accidental Discharge or Overflow from freshwater plumbing, sewer, refrigerator, water heater, or other.
Lightening
Flood from Ground water (Not a broken pipe, not a sewer back up, not from a created opening, not from a leak, not from an appliance. Flood is specific to ground water only.
Other
Type an Option
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Select the type of damage that applies to your claim.

Upload Differences, Positions, and Relevant Supporting Information *

Mark the documents you uploaded *

Contractor estimate(s)

Subcontractor estimates

Invoices/ Receipts

Carrier Estimate(s)

Declarations - Summary (Policy)

Insuring Agreement aka (Policy)

All Endorsements Uploaded (Policy)

Some Endorsements Uploaded (Policy)

Expert Opinion Measurements - Eagle View, Hover, Other

Itel - Expert Opinions

Roof - Expert Opinion

IICRC - Expert Opinion - (Water Smoke Fire)

IH - Expert Opinion - Industrial Hygienist

Engineer - Expert Opinion

Other - Expert Opinion

Carrier Letters and communications (To & From)

Contractors Letters and communications (To & From)

Other

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