Limited Scope & Protocol Waiver

I, the undersigned below have been offered and declined a normal services protocol by CLEAN INDOOR SOLUTIONS LLC and hereby release CLEAN INDOOR SOLUTIONS LLC from any and all liability that could arise as a result of declining the services(s). Furthermore, I also understand that any services offered in lieu of the protocol are by my own choosing and against the recommendation of CLEAN INDOOR SOLUTIONS LLC. I, the owner/agent for the job site listed below, am aware that microbial growth/activity OR “mold” has been detected and is present at my property and is not a result of any action or inaction from the contractor, Clean Indoor Solutions LLC, and fully release the contractor from any liability and responsibility to remediate said mold. Knowing that I may have an exclusion of coverage for any mold clean up or remediation, AND given the cost of remediation, I hereby decline a full scale remediation for my property and elect to have a “limited” clean up or remediation performed. This will entail simply cleaning affected materials to remove obvious growths. This will be limited components that are easily accessible and visibly affected. I also understand and agree that there still may be mold present in areas affected and unaffected after the clean-up process including but not limited to settled spores and areas of growth that may or may not be visible during the clean-up process. I also understand that this clean-up is not a guarantee against future mold growth in areas affected or unaffected. Authorized Antimicrobial Agents: I understand that in the best judgment of Contractor, materials may be treated with a Commercial antimicrobial agent to inhibit the growth of microorganisms during the drying process. I have received advanced notice of the use of antimicrobial and/or antimicrobial product as part of the restoration process. I understand it is beyond the expertise of Contractor to determine if someone is sensitive to its application and will hold Contractor harmless for its use. Cost: In the event coverage is denied by my insurance company, I understand and agree to pay the balance and the cost of remediation. The cost is not to exceed the amount listed below. I have read and understand the information above and have received a copy for my records. *

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Limited Scope & Protocol Waiver

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