Indemnification Agreement
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- Claim number: Auto Make/Model: Vehicle Identification Number : Policy Holder: Description of auto damage to be repaired
- Estimated cost of parts for XXXXXXX Body Shop recommended repair method
- Insurance Company Requested Repair Method
| Indemnification Agreement
This Indemnification Agreement (this “Agreement”) is entered into on the date set forth below by and between XXXXXX, Inc. (“Body shop”) and the automobile owner and insurance company policy holder (Policy Holder) identified in the signature block below with reference to the following facts: Claim number: Auto Make/Model: Vehicle Identification Number: Policy Holder: Description of auto damage to be repaired: Damage sustained due to rear end collision XXXXX Body Shop has recommended repairing the above-referenced damage as follows: Blending both quarter panels per/ manufactures recommendations & paint manufactures recommendations. XXXXXX Insurance refuses to blend both quarter panels. XXXXXXX Body Shop does not feel that the procedure approved by XXXXXX Insurance adjuster XXXXXX was a proper way to repair Mr. XXXXX Vehicle. Estimated cost of parts for XXXXXXX Body Shop recommended repair method: $ XXXX.XX XXXXX Insurance Company has agreed to only pay for XXXXXXX Body Shop to repair the vehicle as follows: Repair the rear bumper and paint Estimated Cost of parts for XXXXX Insurance Company Requested Repair Method: $ XXXX.XX XXXXXXX Insurance Company believes that the repair methods it has requested is reasonably safe and desires XXXXXXX to perform the repair in the manner requested by XXXXXX Insurance Company. XXXXXXX Insurance Company representative, XXXXXX, notified the Policy holder that XXXXXX Insurance Company would not pay the difference in the cost to have the quarter panels blended. In consideration of XXXXXXX Body Shop willingness to make the repair according to XXXXXX Insurance Company’s requested method, Mr. XXXXX understands XXXXXX Body Shop warranty and hereby agrees to defend, indemnify, and hold XXXXXX Body Shop harmless from and against any and all losses, claims, lawsuits, personal injuries, damages, costs, and expenses, including attorney fees, arising from the above-mentioned repair method approved by XXXXXX Insurance Company and myself, XXXXXX, against the recommendation of XXXXXX Body Shop. This ____ day of _______________, 2011. Policy Holder:_________________________________ Printed Name:_____________________ Sworn to and subscribed before me This ___ day of _________, 2011
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