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Lakeshore Public Adjusters Co. 2400 Big Timber Road, Unit #105B Elgin, Illinois 60124 License #100770797 (847) 429-2332 lakeshorepublicadjusters@gmail.com LETTER OF REPRESENTATION Oglesby Avenue DAO LLC Name(s) of insured: Lofty Holding 9919 S _________________________________________________ Address: 9919 S Oglesby Ave. Chicago, IL 60617 Phone #: 518-588-4428 Name of Insurer: Great American E&S Insurance Company c/o Overby-Seawell Company Policy #: 5702951 This is to certify that Lakeshore Publ

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Lakeshore Public Adjusters Co.
2400 Big Timber Road, Unit #105B
Elgin, Illinois 60124
License #100770797
(847) 429-2332
lakeshorepublicadjusters@gmail.com
LETTER OF REPRESENTATION

Oglesby Avenue DAO LLC
Name(s) of insured: Lofty Holding 9919 S
_________________________________________________
Address:

9919 S Oglesby Ave. Chicago, IL 60617

Phone #: 518-588-4428

Name of Insurer: Great American E&S Insurance Company c/o Overby-Seawell Company

Policy #: 5702951

This is to certify that Lakeshore Public Adjusters Co. is hereby retained by your insured Lofty Holding 9919 S Oglesby Avenue DAO LLC
to prepare, assist, advise, and negotiate values of damages incurred for the adjustment of this insurance claim resulting
2025
from the cause of loss Wind/Hail/Rain
____________, which occurred on or about August 18,
_______________
and at the loss location address of

9919 S Oglesby Avenue
Chicago, IL 60617

I/We insured authorize the named Lakeshore Public Adjusters Co. (Public Adjuster) firm to be included as a CO-PAYEE
on all checks/drafts pertaining to this loss as is related to this claim.
Please be advised that I/We insured, pursuant to the loss settlement provisions in our policy of insurance are making claim
for any and all recoverable depreciation, if applicable to our loss.
I/We request a copy of our policy and all endorsements to be forwarded as well as sending of all drafts, documentation,
and/or correspondence pertaining to this loss to Lakeshore Public Adjusters 2400 Big Timber Rd #105B Elgin, IL 60124.
Public Adjuster Regulatory Act
“Pursuant to the Public Adjuster Regulatory Act (III Rev. Stat 1981, ch. 111 par, 751 etseg.) (Amended at 30 III. Reg.
19367, effective November 29th, 2006) Pursuant to Article XXXI3/4 of the code. A contract which is executed within 5
days after the conclusion of the loss producing occurrence shall be voidable at the option of the insured for 10 days after
execution of the contract by registered, or certified mail return receipt requested, or by personal delivery. If after
conclusion of 5 days of the loss-producing event, notice that at the option of the insured, any such contract shall be
voidable for 5 business days after execution and that the written contract shall constitute the entire agreement between the
public adjuster and the insured.”

Public Adjuster Signature

Insured Signature
Earl Co, Member
Lofty Holding 9919 S Oglesby Avenue DAO LLC

Public Adjuster Name

Insured Name

License #

3880 Dover St. Wheat Ridge, CO 80033

Residential Address
_______________________
Date

09/06/2025

Date

License #: 100770797
Phone #: 847-429-2332
lakeshorepublicadjusters@gmail.com
2400 Big Timber Rd. Ste 105B
Elgin, IL, 60124

Public Adjuster Contract
This Public Adjuster Contract (hereafter referred to as "Agreement") is entered into between
_____________________________________________ (full name of the insured), Insured(s) ("Insured"), living at
______________________________________________________(street address/town or municipality/zip) insured by
___________________________(insurance company name)____________________________________ (policy number)
and ________________________________________(full name individual public adjuster and license number) employed
by Lakeshore Public Adjusters Co. ("Public Adjuster"), doing business at 2400 Big Timber Rd. Ste 105B. Elgin, IL 60124 with a
business phone number of 847-429-2332 for the following described services relating to __________________(specify type of
loss/damage) caused by ____________________(cause) which occurred on _______________(date) at approximately
_______(time a.m./p.m.) at _____________________________________________(street address/town or municipality/zip).
Pursuant to the following terms and conditions, the parties agree to the following

1. Term: This Agreement shall become effective upon the full execution of all signatories of this Agreement. No work
shall commence until all parties have signed.

2. Services: Public Adjuster will act as a public insurance adjuster on behalf of Insured and provide the following services:
(specify services to be provided).

3. Fees for Services:
a. Insured understands and agrees that Public Adjuster shall recover its fees based on the amount recovered from
an insurance company for the loss. Public Adjuster's fee shall be due and payable within five business days of
the insurance company making a payment to the insured. Payments from the insurance company may not be
mailed directly to the Public Adjuster. Public Adjuster may not collect the entire fee from the first check.
b. The amount of the Public Adjuster's fee shall be computed as follows: _________(number) percent
_________((numeral) %) of all sums recovered under the insurance contract for this claim. For claims made on
a personal residence, this amount may not exceed 10% of the insurance settlement claim amount paid by the
insurer.

c. Cap on Public Adjuster Compensation: The Public Adjuster may not charge, agree to, or accept any
compensation, payment, commission, fee, or other valuable consideration more than 10% of the amount of the
insurance settlement claim paid by the insurer [used when the property involved is a personal residence].
d. The Insured understands that the Public Adjuster’s fee will be his or her obligation and is not a cost covered by
any insurance policy.

Form LPA
Effective 06/2024

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