Work Authorization First name*Last name*Phone*Email* Date* Date Format: MM slash DD slash YYYY Untitled*Untitled*Untitled*Untitled*Untitled*How you would like to be contacted?PhoneEmailTextMessage*Upload FileTerms and Conditions of Service*By signing this form and accepting this checkbox you are consenting to our Terms and Conditions of Service. Please review entire authorization of all terms and conditions of service, which include various disclosures, disclaimers, and delegation of authority to file with and obtain proceeds from insurance, authorization to communicate with you, an arbitration clause and class action waiver. After you have read the entire authorization, please attest to your understanding and agreement of the terms and conditions of the authorization to repair the vehicle listed. Work Authorization & Responsibility for Vehicle Repairs and Storage (Paragraph 1) I hereby authorize the repair of the vehicle identified above by you, together with the furnishing by you of the necessary parts and other material for such repair and agree that you are not responsible for any delays caused by unavailability or delayed availability of parts or material for any reason; that you neither assume nor authorize any other person to assume for you any liability in connection with such repair; that your employees may operate the above vehicle on the streets, highways, or elsewhere for the purpose of testing and/or inspecting such vehicle; then An express mechanic’s lien is hereby acknowledged on said vehicle to secure the amount of the repairs thereto and I further agree to reasonable attorney’s fees and court costs in the event that legal action is necessary to enforce the contract. You consent to the RPM Collision & Service subcontracting out certain work regarding the repair of your vehicle, at RPM Collision & Service discretion. If the body shop does not receive payment in full from the insurance company within 30 days of the notification of completion of repairs on the vehicle, or if the insurance company denies payment for any repair of part thereof, I agree that I will pay the entire unpaid balance within 15 days of billing. I understand that this is an agreement between me and the body shop and that I am responsible for the body shop payment of any and all cost and expenses to repair the vehicle. I further agree that upon notification by telephone, text or email that the repairs are completed, I will remove the vehicle from the body shop premises within 48 hours or storage fees of $75.00 per day (or part of any day) will occur. If the order for repair is cancelled by you or your insurance, you will be responsible for the cost of teardown, cost of parts and labor to replace items destroyed by teardown, and the cost to reassemble the vehicle. If for any other reason, your vehicle is not repaired, or you decide to stop repairs after the repairs have begun the following charges will apply: $200.00 Charge For Estimate, Labor charges at $52.00 per hour for work already performed, all tow bills, sublet bills, and a 30% restocking fee on all parts ordered prior to cancellation. After Market Parts (If Applicable) (Paragraph 2) Prior to the commencement of the Scope of Work, you (or your insurance adjuster and with your consent) have elected and authorized the use of Aftermarket parts in the repair of your vehicle. RPM Collision & Service has it made clear that the use of Aftermarket parts in the repair of your vehicle may carry risks, including unknown risks as to safety, crashworthiness, and/or ongoing performance of those parts and if a failure occurs may void a portion of your Factory Warranty. The use of these parts is expressly against our professional advice and that of your vehicle’s manufacturer. Therefore, you agree and acknowledge that RPM Collision & Service accepts no liability for the use of Aftermarket parts and/or Salvage parts in the repair of your vehicle, and you agree to indemnify us and hold us harmless for any and all actions, claims, or issues arising from or connected to the use of the Aftermarket parts and/or Salvage parts in the repair of your vehicle. Power of Attorney (Paragraph 3) For consideration of repairs made to this vehicle, I hereby grant power of attorney to sign or endorse checks and or drafts made payable to myself and any release thereto, as settlement for my claim for damage to this vehicle. Direction of Pay (Paragraph 4) Certain, if not all, repairs listed on the attached Estimate(s) may be the subject of a claim made to the insurance company(s). I/we authorize the insurance company to pay RPM Collision & Service the full amount of the attached Estimate and any supplemental Estimates approved by either myself or the insurance company. The payment(s) for the repairs is to be paid directly to and without any encumbrance to the body shop. I understand that any payments received by me from any insurance company concerning the Incident that lead to the damage of the vehicle are to be immediately turned over to the body shop (except payments specifically naming personal injury on the check). Terms (Paragraph 5) I acknowledge that the total estimate of repairs includes all parts, labor, handling and diagnosis and agree that if closer analysis find that additional repairs are necessary, I agree to approve additional supplemental repairs that will be paid from the insurance company. I understand that I will be contacted for authorization if the amount I must pay will be increased. I agree that I need not sign for any other repair to be made so long as I have approved the repairs via telephone, text or email and/or the insurance company representative authorizes the repairs. I acknowledge that acceptable forms of payment include insurance checks, cash, acceptable debit and credit card, and/or cashiers' checks. Disclaimer (Paragraph 6) Under certain circumstances such as fire, theft, or other cause out of their control, Armesh 2000 INC may not be responsible for loss or damage to a motor vehicle or articles left in the vehicle housed at a RPMCollision & Services Center. You have a right to ask an RPM Collision & Services representative about the extent of its responsibility, including the extent of the insurance coverage of the automotive repair facility. RPM Collision & Services is not responsible for valuables left in the vehicle including money, cell phones or other personal electronic devices, etc. All rental coverage and rental rates for vehicle rental while your vehicle is being repaired by Dynamic Collision is your responsibility. Stone Chip (Paragraph 7) Vehicles are prone to stone chips. Vehicles that also have extreme conditions such as driving on gravel roads can cause stone chips in paint as well. RPM Collision & Services has a limited life-time warranty on all refinished panels, however, Stone Chips or any other object that strikes the vehicles refinish panel will not be covered. If defects in painted panel and or part are not removed before refinishing, this may/and or will diminish the value of that painted part. Dynamic Collision will not be held responsible for painting over existing damage. Diagnostic Scan Authorization (Paragraph 8) You authorize RPM Collision & Service to perform pre-repair diagnostic scans on your vehicle for the limited purpose of conducting vehicle diagnostics and/or repairs. In the process of performing a diagnostic scan, including if applicable, the collection of data which may be stored on your vehicle's event data recorder, RPM Collision & Service may collect historical and current vehicle data, including in some cases, the date, time and mileage of when a Diagnostic Trouble Code was created. This information may be helpful in understanding if a problem is accident related or pre-existing. It is possible this information will be shared with your insurance company. Your permission, as indicated by your signature below, grants RPM Collision & Service permission to share this information with others, including your insurance company, or as otherwise required by law. Depending on the condition of the vehicle, the extent of the damage, and other factors, a factory scan tool, to the extent available, may not see every system on the vehicle being scanned. Hold Harmless (Paragraph 9) Customer acknowledges that there are risks inherent with entering into RPMCollision & Service’s place of business. The customer shall not enter into RPM Collision’s shop (other than the reception area) without the express consent of an RPM Collision & Service employee. The customer agrees to hold harmless and indemnify RPM Collision & Service from and against any and all claims or causes of action for personal injury or property damage suffered by Customer as a result of entering into RPM Collision & Service’s place of business. Integration Clause/Amendment Severability (Paragraph 10): This Authorization, together with all attachments as applicable and any written amendment, constitutes the entire agreement between the parties.RPM Collision & Service may modify this Authorization, provided that such modification shall not unilaterally amend the substantive terms of this Authorization. If any part of this Authorization is found invalid or unenforceable by a court of competent jurisdiction, the remainder of this Authorization shall be interpreted so as to reasonably effect the intention of the parties. Arbitration and Class Action Waiver (Paragraph 11): This Authorization and any dispute arising out of or otherwise relating to this Authorization or any matter concerning RPM Collision & Service (collectively “Disputes”) shall be governed exclusively by the laws of the State of Maryland, excluding its conflict of law provisions. If a dispute arises under this Authorization, you and we agree to first contact each other with a written description of the Dispute, all relevant documents and information, and the proposed resolution. You agree to send RPM Collision & Service written notice of such Dispute to RPM Collision & Service,13603 Baltimore Ave Laurel MD 20707. If you and RPM Collision & Service are not able to resolve such a Dispute, you and we each agree that any and all Disputes shall be resolved exclusively by arbitration administered by the American Arbitration Association (the “AAA”) in accordance with its Commercial Arbitration Rules and, in the case of consumer disputes, with the AAA’s Supplementary Procedures for Consumer Related Disputes (collectively, the “AAA Rules”), in a location convenient to you and in the state of service. Either party may commence the arbitration process by submitting a written demand for arbitration with the AAA, and providing a copy to the other party. Judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Unless you opt out using the mechanism below, you expressly agree to refrain from bringing or joining any claims in any representative or class-wide capacity, including but not limited to bringing or joining any claims in any class action or any class-wide arbitration. You understand that you would have had the right. You understand that you would have had a right to litigate through a court, to have a judge or jury decide your case, and to be party to a class or representative action. However, you understand and choose to have any claims decided individually and only through arbitration. You shall have thirty (30) days from the date that you access the Site or submit your personally identifiable information (whichever occurs first) to opt-out of this arbitration agreement. To opt-out of arbitration, you must contact RPM Collision & Service 13603 Baltimore Ave Laurel MD. If more than thirty (30) days have passed, you are not eligible to opt-out of arbitration. I agree to the Terms and Conditions of Service.CommentsThis field is for validation purposes and should be left unchanged.