Shop Authorization and Disclaimer

Industry Advocacy Authorization and Disclaimer

Company Name

First Name

Last Name

Title/Position

Address

City

State

ZIP Code

Country

Phone Number

Email

Website

Type of Business (Choose One)

Auto Glass Repair Auto Glass Repair & Replacement Auto and Flat Glass

The undersigned grants the IGA authority to: (YOU MUST CHECK ALL)

Collect, use, and disclose necessary information related to the Shop and its dealings with third-party administrators and insurance entities. Prepare reports, complaints, and other communications that accurately reflect the Shop's experiences and issues in its professional conduct with third-party administrators and insurers. Submit these documents to the appropriate entities, including local, state, and federal officials, for the purpose of seeking resolution or action. Engage in follow-up communications as necessary to advance the Shop’s interests and concerns.

The undersigned hereby authorizes the Independent Glass Association ("IGA") to act as its agent in the preparation and submission of complaints and communications related to third-party administration and insurance issues affecting the Shop. This authorization includes but is not limited to, the submission of said complaints and communications to local, state, and federal officials, as well as any necessary advocacy groups.

Information Sharing:

The Shop will receive copies of all reports, complaints, and communications submitted by IGA on its behalf, along with updates on the status of these submissions and any responses received.

Disclaimer:

IGA acts solely as an agent on behalf of the Shop and is not responsible for the final outcome of any complaint or issue raised. The Shop acknowledges that IGA does not guarantee a resolution in favor of the Shop and that the handling of any issue will be subject to the procedures and discretion of the entity to which it is submitted.

Limitation of Liability:

The Shop agrees that IGA, its directors, officers, employees, or agents shall not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages, including but not limited to, damages for loss of profits, goodwill, use, data, or other intangible losses resulting from the services provided.

Acknowledgment:

By signing below, the Shop confirms its understanding and agreement to the terms outlined in this Authorization and Disclaimer.