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Adjustment Claim Form

At Black Tar, we want to make your adjustment claim easy. Claims are applicable on projects completed by Black Tar with a valid warranty. Claims can be submitted to address any required adjustments on your completed project such as cracks, heaving, settling, or elevation differences between your asphalt and surrounding area(s).

What's an Adjustment Claim?

An adjustment claim is when you request a free repair (adjustment) for a service provided by Black Tar within the warranty period.

Quote Number

Where can I find my Quote Number?

Name*

First Last

Company Name

Property Address*

Street Address City Province Postal Code

Phone Number*

Email*

Please select the reason this adjustment claim is being submitted:*

Select the Type of Asphalt Paving Claim*

-- Select --

Crack(s)

Rough/Crumbling Asphalt

Lines Apparent

Not Flush w/ Hardscape

Holes In Asphalt

Incorrect Contour (Outline)

Oil Runoff

Rust Stain

Mud Streaks

Vegetation Growth

Pooling

Heaving

Negative Drainage (Water draining to garage/foundation)

Tire Marks

Indents

Third Party Damage

Not Listed / Not Sure

Select the Type of Asphalt Maintenance Claim*

-- Select --

Hot Rubber Peeling

Crack(s) Not Filled

Cold Rubber Peeling

Sealing Applied Unevenly

Sealing Overspray

Ramp Incorrect Elevation

Infrared and Patch Incorrect Elevation

Cut and Patch Incorrect Elevation

Third Party Damage

Not Listed / Not Sure

Select the Type of Property Damage Claim*

-- Select --

Garage Door Panel Damage

Garage Door Trim Damage

Interlock Shift

Interlock Damage

Parging Damage

Eavestrough/Downspout Damage

Vehicle Damage

House Brick Damage

Do you have any Property Damage you need to submit with this claim?*

Yes

Garage Door Panel Damage

1) How many panels are damaged?*

2) Is your garage door still working?*

Garage Door Trim Damage

1) On which side of the garage did the damage occur?*

2) Is your trim metal or wood?*

Interlock Shift

1) Where has the interlock shifting occurred (top left, bottom right)?*

Interlock Damage

1) Where has the interlock damage occurred (top left, bottom right)?*

Parging Damage

1) Where has the parging damage occurred (Left of garage, right of garage...etc.)?*

Eavestrough/Downspout Damage

1) Where has the eavestrough/downspout damage occurred?*

Vehicle Damage

1) Please elaborate on the damage incurred to the vehicle.*

2) When did the damage occur?*

House Brick Damage

1) Where has the house brick damage occurred?*

2) How many bricks are damaged?*

3) Approximately how old is your home?*

4) Do you have any spare bricks with the same colour?*

Crack(s) Not Filled

1) Approximately how many linear feet of cracks were not filled?*

Hot Rubber Peeling

1) Approximately how many linear feet of the hot rubber is peeling?*

Cold Rubber Peeling

1) Approximately how many linear feet of the cold rubber is peeling?*

Sealing Applied Unevenly

1) Does the whole project look patchy, or is it a specific area?*

2) What is the approximate % of the project surface that looks uneven?*

Sealing Overspray

1) Where exactly did the overspray occur?*

2) Have you attempted to clean it yourself (We do not recommend to do so)?*

Yes

Which chemicals have you used?*

Ramp Incorrect Elevation

1) Is the ramp higher or lower than expected?*

2) Have you had any third-party contractors implement work on your property after project completion?*

3) Have you had any heavy machinery/vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Infrared and Patch Incorrect Elevation

1) Is the infrared and patch higher or lower than expected?*

2) Have you had any third-party contractors implement work on your property after project completion?*

3) Have you had any heavy machinery/vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Cut and Patch Incorrect Elevation

1) Is the cut and patch higher or lower than expected?*

2) Have you had any third-party contractors implement work on your property after project completion?*

3) Have you had any heavy machinery/vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Third Party Damage

1) Please elaborate on the type of damage?*

2) How did the damage occur?*

3) Do you know the name of the contractor that caused the damage?*

Not Listed / Not Sure

1) Please elaborate on the type of damage.*

Crack(s)

1) Where is the crack(s) situated?*

2) How many cracks are there?*

3) When did you first notice the crack(s)?*

Rough/Crumbling Asphalt

1) Where is the rough/loose asphalt situated?*

2) Is there more than one rough asphalt area*

Lines Apparent

1) Where are the lines situated (Left, middle, right)?*

2) How many lines are there?*

Not Flush w/ Hardscape

1) Where is the area of concern situated?*

2) Is the asphalt surface higher or lower than the hardscape?*

3) Is the asphalt surface overlapping the hardscape?*

Holes In Asphalt

1) Where are the indents situated (top left, bottom right)?*

2) Have you had any third-party contractors implement work on your property after project completion?*

3) Have you had any heavy machinery/vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

4) Have you ever had a ladder or motorcycle park on your driveway since project completion?*

5) Are you aware of any animals living in or around your driveway?*

Incorrect Contour (Outline)

1) Where is the incorrect contour situated?*

2) Can you provide more information regarding what is incorrect about the contour?*

Oil Runoff

1) Where is the oil runoff situated?*

2) When did the oil runoff occur?*

Rust Stain

1) Where are the rust stains situated?*

2) When did the rust stains occur?*

Mud Streaks

1) Where are the mud streaks situated?*

2) When did the mud streak occur?*

Vegetation Growth

1) Is there water going towards the foundation?*

2) Where is the pooling situated (top left, bottom right)?*

3) Have you had any heavy vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Pooling

1) Is there water going towards the foundation?*

2) Where is the pooling situated (top left, bottom right)?*

3) Have you had any heavy vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Heaving

1) Is there water going towards the foundation?*

2) Where is the heaving situated (top left, bottom right)?*

3) Have you had any heavy vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Negative Drainage (Water draining to garage/foundation)

1) Is there water also going towards the foundation and garage in any other spots?*

2) Is the road higher than your foundation and/or garage floor?*

Tire Marks

1) Where are the tire marks situated (top left, bottom right)?*

2) Have you had any third-party contractors implement work on your property after project completion?*

3) Have you had any heavy machinery/vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

Indents

1) Where are the indents situated (top left, bottom right)?*

2) Have you had any third-party contractors implement work on your property after project completion?*

3) Have you had any heavy machinery/vehicles (Dump Truck, School Bus...etc.) on your asphalt surface?*

4) Have you ever had a ladder or motorcycle park on your driveway since project completion?*

Third Party Damage

1) Please elaborate on the type of damage?*

2) How did the damage occur?*

3) Do you know the name of the contractor that caused the damage?*

Not Listed / Not Sure

1) Please elaborate on the type of damage.*

Pictures (Please submit a minimum of one image per Adjustment Type)*

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 50 MB, Max. files: 5.

Please provide any other comments

Consent*

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(888) 424-5455

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890 Churchill Ave. S, Ottawa, ON

K1Z 5H1

(888) 424-5455

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