Umpire Services - The David Group

Consulting Questionnaire

Please fill out each section to the best of your knowledge.

First Name*

Last Name*

Company Name

Email*

Phone

Name of Insured

Email of Insured

Phone Number of Insured

Date of Loss

Has Damage been found? If so, what is the expected cause of loss?

Has a claim been filed? If so, please give the date the claim was filed and the claim number assigned by the carrier.

Has a "Proof of Loss" or "Partial Proof of Loss" been filed with the carrier? If so, when?

Has work been started or completed? If so, please list the contractor and provide start dates and completion dates (as applicable).

Has appraisal been demanded, or a lawsuit filed? If so, please provide the date and list any additional information - named appraisers, named umpires, contact information, etc.

Additional Comments