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Claim Number: Insurance Company: Attn: HRA Home Improvement Co. 520 N. University St. Murfreesboro, TN. 37130 Tel: 615-410-7924 Fax: 615-410-7926

CERTIFICATE OF COMPLETION

I, the undersigned, (customer name) certify that the installation and repairs ordered by me, (List):_ Has been completed satisfactorily at (address): _, _. In an , do hereby

effort to improve and monitor our customer services, would you please respond to the quality assurance questions to follow. 1) Was the information given during the entire process complete and easily understood as presented? ( )YES ( )NO 2) Are you satisfied with the workmanship and quality provided by our crews?

( )YES ( ) NO

3) Were you satisfied with efforts made to protect your property and the clean up after the work was Complete? ( ) YES ( ) NO 4) Would you recommend us to your friends and associates?

( ) YES ( ) NO

NOTICE TO CUSTOMER: Your signature only reflects the completion of work we were hired to do and in no way affects your warranties, applicable to the products used and/ or labor. CUSTOMER SIGNATURE: DATE:

PLEASE INCLUDE O&P FEIN# 62-1862966 GCL# 62637 Contract was completed based on insurance adjuster's estimate.

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