Authorization Form
I am the owner of the residence indicated below, and I have a homeowners insurance policy covering this residence through Private Client Group, a division of American International Group, Inc. (“AIG”) and underwritten by an AIG member company such as Chartis Property Casualty Company or an affiliate. I hereby authorize members of the Wildfire Protection Unit to enter my property in order to provide a fire retardant application (the “treatment”), as needed or appropriate, in the event that my residence is threatened by a wildfire.

I understand that once I execute this authorization, members of the Wildfire Protection Unit, which includes AIG employees, consultants, and third party vendors, can enter my property at any time during a wildfire in order to apply an emergency treatment. It is the Wildfire Protection Unit’s goal to provide the treatment whenever a residence is threatened by a wildfire that is actively burning within approximately three miles of a residence to be treated.

I understand and acknowledge that the services provided by the Wildfire Protection Unit, including the treatment, may not prevent damage to my property or residence from wildfires. I also understand that there is no guarantee that the Wildfire Protection Unit will be able to apply the treatment to my property before a wildfire damages my property. I HEREBY WAIVE ANY CLAIM AGAINST AIG FOR DAMAGES DUE TO EITHER PERSONAL INJURY OR PROPERTY DAMAGES ARISING OUT OF THE TREATMENT OR LACK OF TREATMENT, OF MY PROPERTY. I AGREE THAT THE SERVICES PROVIDED BY AIG ARE “AS IS” AND AIG SPECIFICALLY DISCLAIMS ALL WARRANTIES TO THE SERVICES EXCEPT AS SPECIFICALLY STATED HEREIN . This waiver does not apply to damage that may occur due to a fire.

I understand that all fees for this emergency service and the treatment will be paid by AIG, and as a policyholder I will not be charged for this service. AIG has the right to terminate this service at any time and for any reason. I understand that this service will automatically terminate if I am no longer a policyholder. I also understand that my participation is totally voluntary. Additional information regarding other services, such as permanently installed fire mitigation systems, can be obtained by calling the Risk Management Resources Hotline: 800 899 2409.

Homeowner should consult with the local fire department, wildfire mitigation personnel or local forest service personnel regarding removal of vegetation and other fuel sources for fires around the home.

1 If fire retardant is applied, reasonable costs for clean-up or damages caused to the property by the Wildfire Protection Unit due to fire retardant spray will be paid for by the insurance company. No deductible applies.

     Policy Number:        Policy Effective Date:      (MM/DD/YYYY)    

Please enter a valid policy number and effective date to enroll in the program. Quote numbers cannot be used. To enroll a quote, email the enrollment form to


© 2012 American International Group, Inc. All rights reserved.