Hereby retains Barclays Public Adjusters, to be the agent and representative for the insurance contract with

In consideration of the above services, the insured hereby assigns and agrees to have Barclays Public Adjusters represent the above loss and agrees to pay Barclays Public Adjusters ten percent (10%) of the total amount of the proceeds paid for the entire claim of the insurance benefits for said loss, including all monies paid as attorneys fees or extra-contractual damages, which are recovered either from the adjustment or other representation.

Barclays Public Adjusters may engage, at Barclays Public Adjusters' sole discretion, professionals to render services on behalf of Insured, including but not limited to appraisers, umpires, engineers, meteorologists, architects, and contractors, amongst other professionals (hereinafter referred to as Professionals/Experts). Barclays Public Adjusters may make advances of these expenses on behalf of Insured in such amounts as Barclays Public Adjusters shall determine to be in the best interests of Insured in this matter. Barclays Public Adjusters will use its best efforts to get all Professional/Expert expenses recovered from the insurance company. Insured's recovery shall be reduced by the amount such Professionals/Experts charge, which shall be reimbursed to Barclays Public Adjusters or otherwise paid to the Professional/Expert. Insured understands that all Professional/Experts are independent contractors and not employees of the Barclays Public Adjusters and the Barclays Public Adjusters shall not be responsible for any claims arising out of the alleged or actual negligence, misconduct, misfeasance, malfeasance, or any other act or omission of the Professional/Expert.

Any notification after that date shall deem the insured responsible for all costs incurred by Barclays Public Adjusters to the date of cancellation. If a dispute arises relating to this contract, the prevailing party shall be entitled to recover all Barclays Public Adjusters fees and court costs incurred by this event.

Pursuant to Florida Statute 817.234, any person who, with the intent to injure, defraud, or deceive any insurer o insured, prepares, or causes to be represented a proof of loss or estimate or cost of repair damaged property in support of a claim under an insurance policy knowingly that the proof of loss or estimate of the claim of repairs contains any false, incomplete or misleading information concerning any fact or thing material to the claim commits a felony in the third degree, punishable as provided by Florida Statutes 775.082, 775.083 and 775.084.

Check Exchange (please initial) Upon receipt of insurance benefits, Barclays Public Adjusters will endorse the check(s) in favor of the Insured in exchange for payment by way of a check, cash, or cashier's check for the associated public adjusting Barclays Public Adjusters, who will negotiate the check and issue a check (once the funds clear) back to the insurance benefits in favor of payees after deducting the associated public adjusting fees and costs.

***One signature is required when only one (1) Homeowner/Title Owner is submitting form.

***Two signatures are required when there are two (2) Homeowners/Title Owners submitting form