Insurance Claim Disputes (Feb. 2014) | Page 12

COMPANY NAME Address; Phone License Number(s) CERTIFICATE OF COMPLETION & SATISFACTION “IT’S ABOUT JUSTICE” Job Site Address: ________________________________________________________________________ Customer Name: ________________________________________________________________________ Job # : _________________________________ Completion Date: ________________________ I have had an opportunity to walk the job site located at the above address and inspect the work area. A representative from (COMPANY NAME) has explained the work performed. I see no problems associated with services performed by (COMPANY NAME). All of my questions have been answered to my satisfaction and (COMPANY NAME) scope of work has been completed to my entire satisfaction. However, I will promptly report any problem to (COMPANY NAME), and give (COMPANY NAME) a full and fair opportunity to address them. I HAVE READ THIS CERTIFICATE AND AGREE THAT THE FOREGOING STATEMENTS ARE TRUE. Owner/Owner’s Agent (Must be at least 18 years old) (Company Name) __________________________________ Signature of Owner/Agent(Circle One) ____________________________________ Signature of Company Representative __________________________________ Print Name and Title ____________________________________ Print Name and Title