Crestview Public Adjusters LLC

92 S State Street.

Hackensack, NJ 07601

Josh@crestviewpa.com

201-686-2022

4/19/2024
Date: ______________
12pm
Time: ______________

The undersigned “insured” hereby engages Crestview Public Adjusters LLC (Public Adjuster) to advise and assist in the
Wind
adjustment of the claim AGAINST the insurance companies covering the loss arising from___________________ or other
2
cause occurring on the ______ April, 2024
day of ____________ 12pm at ________________________________
at or around _____ 140 E Lawn Dr Teaneck, NJ 07666-5658 insured

15% of the amount paid by the insurance companies in

agrees to pay the Public Adjuster for such services a fee of ______
settlement of the loss, and reasonable expenses, hereby assigning to the Public Adjuster all monies due or to become due
from the insurance companies as security to the extent of the Public Adjuster’s fee and expenses. The fee shall be due after
proofs of loss are sworn to and/or first proceeds issued. The Public Adjuster hereby agrees to perform the said services in
return for the consideration described herein. This agreement contains the entire agreement between the parties and may
not be changed in any way except in writing, signed by all the parties hereto. You may cancel this contract prior to
midnight of the third business day after the above date without further obligation, as listed below. See the
attached NOTICE OF RIGHT TO CANCEL, for further explanation. After that time, if you terminate the
contract, you remain obligated to pay from any insurance proceeds recovered, either prior to or after the
date of termination, a fee for the reasonable value of services provided by Crestview Public Adjusters.

By: ________________________________ Date: _________________________

Yafreisi Perez
_____________________________________ _____________________________________
Yafreisi Perez (Apr 19, 2024 12:28 EDT)
Printed Insured Insured Signature

4/19/2024
___________________
Date

Josh Berkowitz
_____________________________________ _______________________________________
Printed Public Adjuster Public Adjuster Signature

4/19/2024
____________________
Date
 Crestview Public Adjusters LLC
92 South State Street.

Hackensack, NJ 07601

Josh@crestviewpa.com

201-686-2022

NOTICE OF RIGHT TO CANCEL

(DATE OF CONTRACT)

You may CANCEL this contract without any Penalty or Obligation, within THREE BUSINESS
DAYS from the above date, or NOT LATER THAN MIDNIGHT OF 4/24/2024 .
If you exercise this right to cancel this contract, you will be liable for reasonable and necessary
emergency out-of-pocket expenses or services which were paid for or incurred by the Public Adjuster
to protect the interests of the insured during the period preceding cancellation. If you cancel this
contract within THREE BUSINESS DAYS, anything of value given by you under the contract will be
returned to you within TEN BUSINESS DAYS following receipt by the Public Adjuster of your
cancellation notice, and any security interest arising out of the contract will be canceled.

If you exercise your right to cancel this contract after the third business day, you will remain
liable for the above-stated Public Adjuster fee on all monies paid or offered by the insurance
companies in settlement of the loss which resulted in whole or in part from the Public Adjuster’s
valuable work and services, as well as the Public Adjuster’s reasonable expenses, and any security
interest arising out of the contract will remain in force.

To cancel this contract, mail, fax or deliver in person a signed and dated copy of this notice or
any other written notice, indicating your intent to cancel and the date thereof to 4/24/2024 .

I HEREBY CANCEL THIS CONTRACT.

(SIGNATURE)

(DATE)

(SIGNATURE)
(DATE)
140 E Lawn Dr Teaneck, NJ 07666-5658
Final Audit Report 2024-04-19

Created: 2024-04-19

By: Josh Berkowitz (Josh@crestviewpa.com)

Status: Signed

Transaction ID: CBJCHBCAABAAnA1D17ZfUQME1VqdYhWAoksma0aO7kP8

"140 E Lawn Dr Teaneck, NJ 07666-5658" History

Document created by Josh Berkowitz (Josh@crestviewpa.com)
2024-04-19 - 2:13:03 PM GMT- IP address: 181.208.42.111

Document emailed to yafreisiperez@gmail.com for signature

2024-04-19 - 2:13:28 PM GMT

Email viewed by yafreisiperez@gmail.com

2024-04-19 - 3:41:53 PM GMT- IP address: 172.226.198.19

Signer yafreisiperez@gmail.com entered name at signing as Yafreisi Perez

2024-04-19 - 4:28:15 PM GMT- IP address: 207.45.166.14

Document e-signed by Yafreisi Perez (yafreisiperez@gmail.com)

Signature Date: 2024-04-19 - 4:28:17 PM GMT - Time Source: server- IP address: 207.45.166.14

Agreement completed.
2024-04-19 - 4:28:17 PM GMT