Sec.38a-788-6. Form of contract

No public adjuster shall enter into an employment contract except in conformity with this regulation. There shall be a true copy of the employment contract which shall be given to the client at the time the contract is signed. The contract and all copies of the contract shall (1) be printed on white or cream paper in dark or black ink; (2) have section titles captioned in bold face type which otherwise stands out significantly from the text; (3) have statements on the contract which read "read both sides before signing" and "I have read the information on both sides of this contract" printed in 18 point bookman type; (4) use layout and spacing which separates the paragraphs from each other and from the border of the paper; and (5) be on one piece of paper measuring 8½" x 11" to be printed on both sides and which shall state:

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(1) On side one:

INFORMATION ABOUT YOUR

PUBLIC ADJUSTER EMPLOYMENT CONTRACT

YOUR LEGAL RIGHTS:

Cancellation: You may cancel this contract by notifying us at the address shown on the other side of this page, in writing, by certified mail, return receipt requested, or, if agreed upon by you and us, by electronic means with proof of a delivery receipt posted or delivered not later than midnight of the fourth calendar day following the day this contract is signed. If the contract is signed on a Friday, Saturday or Sunday, you will have until midnight on the following Thursday to send the notice of cancellation to us as described above.

Settlement offer: We shall forward to you any written settlement offer from the insurance company.

Fee: Our services are available for a fee to be paid by you. We cannot charge you a fee greater than ten percent (10%) of the actual or final settlement of the loss covered by this contract nor can we rebate any part of the fee specified in this Employment Contract.

Copy of the contract: We must give you a true copy of this Employment Contract at the time you sign it.

LIMITATIONS OF PUBLIC ADJUSTERS:

We are not allowed:

—to solicit your employment between 8:00 p.m. and 8:00 a.m.

—to solicit your employment if you have already hired or contracted with another public adjuster.

—to have any interest whatsoever in any construction, salvage, or appraisal business.

—to represent both an insurer and an insured at the same time.

—to pay anything of value to any person as an inducement to refer business to us.

—to share our fee, except with another licensed Public Adjuster.

—to advise you on any question of law.

—to advance any monies to you before settlement of the loss, where such amount would be included in the final settlement.

—to make false statements about an insurance company or its representatives.

We must:

—sign this Contract.

—inform you that we do not represent any insurance company or any insurance company adjusting firm.

(2) On side two:

*NAME OF LICENSED PUBLIC ADJUSTER ADDRESS TELEPHONE NUMBER
________________________________ Names of individual public Adjuster licensee(s) to appear here

READ BOTH SIDES BEFORE SIGNING(18 point bookman type)
PUBLIC ADJUSTER EMPLOYMENT CONTRACT
To the Interested Insurance Companies and Others Whom it May Concern: I/we
retain _____________________________________________________ to act
	(name of public adjuster)
as my/our public adjuster(s) and to advise and assist in the adjustment and settlement
of my/our ________________________________________________ loss at
	(type)
___________________________________________ which occurred on or
	(address)
about ___________________. In consideration for these services, I/we hereby
(date)
assign out of the monies due or to become due from said Insurance Companies on
account of the said loss a sum equivalent to ________ % percent of the amount of
the loss when adjusted with the Insurance Companies or otherwise recovered.

________________________	Signed:	____________________________
(date)		(signature of insured)
		____________________________
		(signature of insured)
		____________________________
		(name)
		____________________________
		(address)
		____________________________
		(city & state)
	Agreed to:	____________________________
		(name of individual or firm licensee)
	By:	____________________________
		(signature of public adjuster)

This form is in compliance with Section 38a-788-6 of the Regulations of Connecticut State Agencies. This form must be signed by the licensed Public Adjuster and by the Insured.

_______________________________________________________________________

*The name of the licensee must appear here. If you operate as a firm or on behalf of a firm, show name of firm licensee here and names of all individual licensees in designated area.

(Effective September 25, 1992; Transferred June 22, 1995; Amended June 3, 2020)