LABOR CLAIM ONLY SUPPLEMENT FORM

THIS FORM IS FOR SERVICE PROVIDERS ONLY. For homeowner / end-user reimbursement, do not fill out this form. Instead, use this form.

Repairs must be pre-approved by Navien's Technical Support team before labor can be considered.

Please complete this form in its entirety. Submit this together with a labor bill/invoice.

Today's Date:

RGA Number (Mandatory):

Repairs must be pre-approved by Technical Support before claiming labor.

Homeowner Information

Name:

Address:

City:

State:

Homeowner Zip Code:

Homeowner Phone Number:

Homeowner Email:

Contractor Information

Company Name:

Contractor Address:

Contractor City:

Contractor State:

Zip Code / Postal Code:

NSS ID Number

Contractor Contact Number:

Contact Email:*

Jobsite Information

Defective Unit Serial Number:*

Replacement Unit Serial Number (if applicable):

Initial Installation Date:

Serviced Date(s):

Explanation of the work performed

ATTACH UP TO 2 FORMS HERE:

Invoice
Tax Form (see below)

About Tax Forms:

If this if your first labor claim with Navien, you will need to attach a copy of your tax form.

W9 (for US entities)
W-8BEN or W-8BEN-E (for Canada).

The address on your tax form is the address we will use for payments.

For blank tax forms, please email claims@navien.com.

Drag and drop files here or

Labor Rate:

All approved Limited Labor Warranty claims are paid out as follows: 1 hour travel time + 1 hour to diagnose and replace the part(s) approved in the RGA @ $75 per hour for a maximum of $150 allowed per RGA.

EFFECTIVE NOV. 1, 2022

New labor rates will be in effect for any RGAs created on or after Nov. 1, 2022 will be $120 per hour. New max per RGA will be $240.

*Exceptions:

•An additional hour is allotted when an entire water heater or a primary/secondary heat exchanger is being replaced under warranty ($225 maximum payout before Nov. 1, 2022 / $360 on or after Nov. 1, 2022).

•For multiple unit job sites - If multiple units are identified as requiring part replacements, travel time will only be allowed on the first RGA.

Non-Reimbursement of Labor Claims:

Labor claims will not be reimbursed for:

•General and routine maintenance (such as inlet filter and flow sensor cleaning)•Unauthorized unit or part replacements•Units cannot be substituted as payment for labor claims•Expired labor warranties

Incidentals:

•We do not pay for any extra material that is used while replacing units.

•Parts kits are available to reduce labor costs.

•Navien doesn’t pay additional for overtime, holidays, out-of-service areas, and for any taxes or GST on any labor.

•An RGA Form must be completed and submitted for each RGA.

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