Westhill – Direction to Pay Policyholder Name(Required)Claim Number(Required)To: ("Insurance Company")(Required)Date(Required) MM slash DD slash YYYY I, the undersigned policyholder, acknowledge that Westhill Global, Inc. (“Westhill”) mobilized the selected contractor (“Network Participant”) to complete the necessary work to restore, remediate, rebuild, and/or repair certain property (“Construction Services”) as authorized by me and Insurance Company in the applicable Work Authorization, on the listed date, in relation to the above listed claim. I understand this Direction to Pay authorizes and extends solely to the Construction Services covered by the Insurance Company as related to the above listed claim. I agree to pay for any additional services, repairs, or improvements made at my direction and that are not covered under my policy with Insurance Company.Accordingly, in relation to such Construction Services for the above listed claim, I hereby authorize Insurance Company to pay Westhill directly for all unpaid sums under the Work Authorization, in the amount listed below:Amount:(Required)To the extent this does not occur, I agree to promptly remit such unpaid sums to Westhill directly. By signing below, I hereby authorize the Direction to Pay on the terms set forth herein.Signature(Required) Δ
