PEO Insurance Brokers Network looks forward to doing business with your agency and beginning a great working relationship.
|
|
- Derrick Chambers
- 5 years ago
- Views:
Transcription
1 Dear Referral Partner: PEO Insurance Brokers Network looks forward to doing business with your agency and beginning a great working relationship. CHECKLIST Legible copy of your current broker s license Legible copy of your broker s bond (If applicable) Copy of your current E & O policy declaration page Completed brokerage contract Completed producer questionnaire Completed W-9 form Please send the completed information to: PEO Insurance Brokers Network Fax: quotes@peobrokersnetwork.com
2 Referral Partner Questionnaire Page 1 of 2 Legal Agency Name: DBA: Mailing Address: Street Address: Phone Number: Fax Number: Agency Type: Retail Whole Sale Both Agency is a: Partnership Sole Proprietorship Corporation S-Corp Date Agency Established: Federal ID or Sec. No.: Name and addresses of all persons having an ownership interest in agency. Please attach additional sheets if necessary. Name of Owner/Principal: Home Address: City: State: Zip: Total number of employees: Total number of producers Key Employees: Name: Title
3 Producer Questionnaire Page 2 of 2 Have you or anyone in your agency been sued concerning insurance related activities? Yes No If yes, please explain on a separate sheet and attach to this form Have you, your employees, or your agency ever been disciplined by any State Agency or Department of Insurance? Yes No If yes, please explain on a separate sheet and attach to this form Has any Errors & Omission claims been made in the most recent five years against your agency, officer, partners or owners? Yes No If yes, please explain on a separate sheet and attach to this form Financial Information: Bank Name: Mailing Address: City State Zip Routing # Trust Account # Average Balance: $ Do you have overdraft protection? Yes No Please list companies and MGA s you place business with in order of premium Carrier/ MGA: Annual Premium: Loss Ratio
4 It is agreed that the statements on this application or any material submitted herewith are true and accurate representation of the applicant and they shall be deemed material to the acceptance of risk(s) from the brokerage by PEO Insurance Brokers Network Name (please print): Title: Signature: Date:
5 Limited Referral Partner Agreement This agreement is made and entered between PEO Insurance Brokers Network and Referral Partner: Mailing address: Hereinafter producer 1. Producer shall have no authority to bind any coverages on new or renewal business or claim hereunder, or make any changes in terms and conditions of any policy of insurance 2. Producer shall have no authority to issue a binder in the name of PEO Insurance Brokers Network or any company represented by PEO Insurance Brokers Network 3. In the event an unauthorized binder issued by the producer through PEO Insurance Brokers Network or any company represented by PEO Insurance Brokers Network, suffers loss, producer agrees to indemnify, hold harmless and defend PEO Insurance Brokers Network and/or any company represented by PEO Insurance Brokers Network against any judgment or settlement and for all loss and expense, including but not limited to, attorney fees and investigation costs, incurred by PEO Insurance Brokers Network or any company represented by in the payment or defense or claim or loss resulting from said unauthorized binder. 4. PEO Insurance Brokers Network will allow producer commissions at such rates as agreed to between parties hereto. In the event of any return premium becoming due for any reason whatsoever, producer shall refund any associated commission to PEO Insurance Brokers Network at the same rate at which the commission was originally allowed. It is agreed that there will be no commission paid on any policy fees, taxes or other fees added to the policy. 5. Producer agrees that no flat cancellation shall be allowed. Producer will pay to PEO Insurance Brokers Network any and all open accounts, accounts stated or other indebtedness arising out of or relating to policies of insurance under this agreement. Producer further guarantees to pay earned premiums (Including minimum premiums and collected audit premium) and all other fees and charges for the time coverage is in force and effect on any and all insurance policies written through facilities of PEO Insurance Brokers Network. Producer shall be responsible for arranging for the return to the insured any unearned premium and unearned commissions that belong to the insured. Producer shall remit all payments to PEO Insurance Brokers Network within 10 days of producers receipt of such payment. Producer shall hold all payments received from insured in trust until payments are transmitted to PEO Insurance Brokers Network. No payment accepted or received by producer shall be deemed paid to PEO Insurance Brokers Network until such payment shall be received in hand PEO Insurance Brokers Network. Any violation
6 of the foregoing shall be considered a breach of the producer s fiduciary responsibilities and obligations to PEO Insurance Brokers Network and its insurance companies and MGA(s). Producer recognizes that any violation of the terms of this paragraph shall be sufficient cause for rescission of this agreement. 6. The producer may submit business from the State of California. It is agreed that within California, the producer shall be free to exercise his/her judgment as to the person (s) solicited and the time, manner, means and place of solicitations, and PEO Insurance Brokers Network shall not be responsible for any expenses incurred by the producer in such solicitations, or any brokerage expense. 7. The producer is not an agent; employee or representative of PEO Insurance Brokers Network or nay company represented by PEO Insurance Brokers Network. No act of the producer shall be binding on PEO Insurance Brokers Network or any company represented by PEO Insurance Brokers Network. The producer represents that he/she is fully authorized under the laws of the State of California. The producer shall be transacting business on behalf of his/her client and not PEO Insurance Brokers Network. 8. PEO Insurance Brokers Network will take reasonable steps to give the producer reasonable advance notice of the expiration of all policies, but failure to provide such notice shall not render PEO Insurance Brokers Network liable in the regard. So long as the producer remains current, accounting for and paying all accounts for which he/she is liable, the producers records and use and control of expiration(s) shall be deemed the property of the producer and remain in his/her sole possession, and control. In the event that the producer defaults on any accounts for which he/she may be liable, PEO Insurance Brokers Network has the right to cancel, revoke, or rescind this agreement and immediately retain control of any and all accounts in default, which are in the producer s possession and control. 9. Producer agrees to indemnify and hold harmless PEO Insurance Brokers Network, any of its employees, agents, underwriting companies, claim adjusting companies, or insurance companies, from and against any and all claims arising out of or relating to any alleged act or alleged failure to act by the producer which results in any claim, loss, aware, penalty, demand, action or cause of action be meritorious. Producer agrees to promptly notify PEO Insurance Brokers Network of any claim, demand, action or cause of action made against producer. Producer agrees to indemnify PEO Insurance Brokers Network and/or any of its underwriting companies, claim adjusting companies or insurance companies from any and all loss, expense, settlement or judgment including expense of investigators, expert witnesses, court costs, and attorney fees arising from or relation to any alleged failure to act on the part of the producer whether or not said claim, loss, award, penalty, demand, action or cause of action be meritorious.
7 10. Producer agrees to indemnify and hold harmless PEO Insurance Brokers Network, its shareholders, directors, and employees, against any and all claims, demands, actions, liability, losses, damages, penalties, judgments, costs and expenses, PEO Insurance Brokers Network limitation, attorney fees, disbursements and court costs, made or instituted against, by PEO Insurance Brokers Network, its shareholders, directors and employees which arise directly or indirectly out of any act or omission of the producer, or its employees or representatives. 11. PEO Insurance Brokers Network agrees to indemnify and hold harmless producer, any of its employees, agents, or representatives, from and against any and all claims arising out of or relation to any alleged act or alleged failure to act by PEO Insurance Brokers Network, which results in any claim, loss, award, penalty, demand, action or cause of action against producer or any of its employees, agents, or representatives, whether or not said claim, loss, award, penalty, demand, action or cause of action be meritorious. PEO Insurance Brokers Network agrees to promptly notify producer of any claim, demand, action or cause of action made against PEO Insurance Brokers Network. PEO Insurance Brokers Network agrees to indemnify producer, any of its employees, agents, or representatives from any and all loss, expense, settlement or judgement including expenses or investigators, expert witnesses, court costs, and attorney fees arising from or relating to any alleged failure to act on the part of the PEO Insurance Brokers Network, whether or not said claim, loss, award, penalty, demand, action or cause of action be meritorious. 12. Producer agrees to indemnify and hold harmless PEO Insurance Brokers Network, any of its employees, agents, underwriting companies, claim adjusting companies, or insurance companies, from and against any and all claims arising out of or relating to any alleged act or alleged failure to act by a producer, in reliance on the producer s capacity as power of attorney for any third party, which results in any claim, loss, award, penalty, demand, action or cause of action against PEO Insurance Brokers Network or its underwriting companies, claim adjusting companies, or insurance companies, whether or not said claim, loss, award, penalty, demand, action or cause of action be meritorious. 13. PEO Insurance Brokers Network agrees to indemnify and hold harmless producer, its employees, agents, or representatives against and in respect of any and all claims, demands, actions, liability, losses, damages, penalties, judgments, costs and expenses, including without limitation, attorney fees, disbursements and court costs, made or instituted against, or incurred by producer, its employees, agents, or representatives, which arise directly or indirectly out of any act or omission of PEO Insurance Brokers Network, or its employees or representatives. 14. Producer in placing business under this agreement recognizes that producer is a representative of the insured and is not acting as an agent or representative of PEO Insurance Brokers Network or its insurance companies, or claim adjusting companies. 15. Neither PEO Insurance Brokers Network nor the insurance company shall bear responsibility for any expense incurred by producer, regardless of the origin of the expense incurred.
8 16. Producer shall abide by the California Fair Claims Settlement Practices Regulations when handling claims. 17. In the event of any dispute arising between the parties relating to this agreement, it is agreed that the only venue for litigation shall be Orange County, California. It is also agreed that the prevailing party in any such litigation shall be entitled to recover all reasonable attorney fees, legal fees and costs, and other expenses arising out of such action. 18. Producer agrees that producer will provide each insured with an explanation of the terms and provisions of the policy of insurance including, but not limited to coverage being afforded, amendments and exclusions contained within the policy of insurance. 19. Producer shall not reproduce and/or distribute any sample insurance policies to nay party, other than a prospective insured in the normal course of business. Producer shall not post or cause to be posted, any sample policy or current policy of an insured on the internet or any internet website at any time. 20. Producer agrees to keep in full force and effect an errors and omissions insurance policy with limits no less than $1,000,000 during the full term of this agreement and if requested will send a copy of the policies to PEO Insurance Brokers Network. 21. In the event any provision of this agreement shall be held illegal or invalid for any reason, the illegality or invalidity shall not affect the remaining parts of the agreement, and the agreement shall be construed and enforced as I the illegal or invalid provision(s) had not been included. 22. This agreement superseded and replaces any and all previous agreements and shall be effective as of the date entered below and shall remain in full force and effect until cancellation/ Cancellation may be effectuated by wither party providing written notice of cancellation by mail to the party s last known address. Cancellation of this agreement will become effective after the date of mailing and any such cancellation shall comply with the laws of the State of California. 23. Failure to abide by all the terms and conditions of this agreement will result in the immediate suspension or termination of this producer agreement, at the sole discretion of PEO Insurance Brokers Network.
9 In witness whereof, the parties hereby enter into this agreement on This day of year PEO Insurance Brokers Network Signature: Print Name: Title: Producer IRS # Signature: Print Name: Title:
10
11
12
13
14
Please fax or the completed information to Sam Frappalini: ( fax) or
Dear Broker TGI, Inc looks forward to doing business with your agency and beginning a good working relationship. Checklist Legible copy of your current broker s license Legible copy of your broker s bond
More informationLIMITED PRODUCER AGREEMENT
LIMITED PRODUCER AGREEMENT THIS PRODUCER AGREEMENT (the Agreement ) is made as of by and between, SAFEBUILT INSURANCE SERVICES, INC., Structural Insurance Services, SIS Insurance Services, SIS Wholesale
More informationTexas FAIR Plan Producer Requirements and Performance Standards
Texas FAIR Plan Producer Requirements and Performance Standards John W. Polak, CPCU 2002 The following Texas FAIR Plan Association ("Association") requirements and producer performance standards ("Requirements
More informationBrokerage Agreement Between Standard Lines Brokerage, Inc. (Hereinafter called SLB) and. (Hereinafter called Agency)
Brokerage Agreement Between Standard Lines Brokerage, Inc. (Hereinafter called SLB) and (Hereinafter called Agency) Agency s Federal Identification Number THIS BROKERAGE AGREEMENT ( Agreement ) is made
More informationApplication for Appointment Packet
Application for Appointment Packet Thank you for your interest in Empire Underwriters LLC. In order for us to process your request, we need the following information. o Broker Information Sheet Completed
More information(This Agreement supersedes all prior Agreements) AGREEMENT
(This Agreement supersedes all prior Agreements) AGREEMENT AGREEMENT, dated day of, 20, between International Transportation & Marine Agency, Inc., a corporation organized and existing under and by virtue
More informationG. J. Sullivan Co. Insurance Services Sullivan Brokers Wholesale Insurance Solutions PRODUCER AGREEMENT
G. J. Sullivan Co. Insurance Services Sullivan Brokers Wholesale Insurance Solutions PRODUCER AGREEMENT Please provide the following required documents: Copy of Producer s License Signed Producer Agreement
More information3. Producer agrees that any materials furnished by Pro General shall always remain the property of Pro General and shall be returned upon demand.
This producer s agreement (the Agreement ) made this day of, 20 by and between Pro General Insurance Solutions, Inc. (hereinafter called Pro General ) and DBA, an insurance agency, (hereinafter called
More informationPRODUCER AGREEMENT PACKAGE
PRODUCER AGREEMENT PACKAGE Thank you for your interest in writing business with Evolution Insurance Brokers, LC ( EIB ). Attached is a copy of our Independent Producer s Agreement ( Agreement ), which
More informationJSA PRODUCER AGREEMENT
JSA PRODUCER AGREEMENT This Producer Agreement (hereinafter, Agreement ) is entered into by and between Jackson Sumner and Associates, Inc. a North Carolina Corporation having its principal place of business
More informationMAISON MANAGERS, INC. Florida PRODUCER AGREEMENT
THIS AGREEMENT, effective as of, MAISON MANAGERS, INC. Florida PRODUCER AGREEMENT by and between Maison Managers, Inc., a corporation ("Maison Managers"), and (indicate type of entity such as individual,
More informationHull & Company, LLC Tampa Bay Branch PRODUCER AGREEMENT
Hull & Company, LLC Tampa Bay Branch PRODUCER AGREEMENT THIS PRODUCER AGREEMENT (this Agreement ), dated as of, 20, is made and entered into by and between Hull & Company, LLC, a Florida corporation (
More informationAgent Appointment. Application / Contract
Agent Appointment Application / Contract Last Updated: 2.7.2017 AGENT APPOINTMENT APPLICATION/CONTRACT Please follow each of the steps below in order to assure efficient processing of your FirstCare Health
More informationHULL & COMPANY, INC. DBA: Hull & Company MacDuff E&S Insurance Brokers PRODUCER AGREEMENT
HULL & COMPANY, INC. DBA: Hull & Company MacDuff E&S Insurance Brokers PRODUCER AGREEMENT THIS PRODUCER AGREEMENT (this Agreement ), dated as of, 20, is made and entered into by and between Hull & Company,
More informationFax #: Website: Note: All Commissions and Invoices will be sent to the above mailing address, unless otherwise specified in writing.
How Did You Hear About Us? Internet Mailer Referral Convention Other AGENCY QUESTIONNAIRE Business Tax I.D. #: - Year Established Business Type: Corp. Individual/Sole Partnership LLC Agency : Street Address:
More informationAUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1)
AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1) Name of Brokerage or Agency as Licensed Date Address (street, city, state, zip) Telephone Mailing Address or "Trade Name" if Different than Above Individual
More informationNATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT
NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT This Agreement between National Insurance Underwriters, LLC., with principle offices located at 800 Yamato Road, Suite 100, Boca Raton, FL
More informationAGREEMENT made as of by and between Empire BlueCross BlueShield (Empire), with offices located at 11 West 42nd Street, New York, NY and
EMPIRE USE ONLY Rep Name: Rep Code: INSURANCE PRODUCER AGREEMENT AGREEMENT made as of by and between Empire BlueCross BlueShield (Empire), with offices located at 11 West 42nd Street, New York, NY 10036
More informationBroker Agreement. 135 Crossways Park Drive, P.O. Box Woodbury, NY Fax:
Broker Agreement This Agreement is made on the day of, 2 by and between Sterling & Sterling, Inc., DBA SterlingRisk, hereinafter referred to as SterlingRisk. and on behalf of its direct and indirect subsidiaries
More information21 st CENTURY GENERAL AGENCY, INC. Commercial Business Producers Agreement
21 st CENTURY GENERAL AGENCY, INC. Commercial Business Producers Agreement The parties hereto, in consideration of the mutual promises set forth herein, agree as follows Section 1 AUTHORIZATION AND AUTHORITY
More informationRegistered Representative / Investment Advisor
Multiple Financial Services, Inc. Registered Securities Broker Dealer - Member NASD/SIPC Registered Representative / Investment Advisor Employment and Account Agreement Registered Representative / Investment
More informationProducer Agreement. This Producer Agreement made and entered into as of the Effective Date by and between:
Producer Agreement This Producer Agreement made and entered into as of the Effective Date by and between: And, 1. Preferred Concepts, LLC, Preferred Concepts, Inc., IRF Administrators, LLC, PCI Enterprises,
More informationTERMS AND CONDITIONS OF SERVICE
(Please Read Carefully) All shipping services for any exporter, importer, sender, receiver, owner, consignor, consignee, transferor or transferee (herein called the Customer ) provided by Transpak, Inc.
More informationDirect Deposit Setup Instructions:
Direct Deposit Setup Instructions: 1. Provide IRS Letter of Incorporation or State Business Registration Certificate. 2. Complete the following forms for the Company setup, please ensure that you sign
More informationPREPARED MANAGERS, LLC LIMITED AGENCY AGREEMENT. THIS INDEPENDENT AGENCY AGREEMENT, (this Agreement ) is made and entered into between
PREPARED MANAGERS, LLC LIMITED AGENCY AGREEMENT THIS INDEPENDENT AGENCY AGREEMENT, (this Agreement ) is made and entered into between PREPARED MANAGERS, LLC (the Company ) and (the Agent ). Prepared Managers,
More informationSUB-PRODUCER AGREEMENT
SUB-PRODUCER AGREEMENT THIS AGREEMENT is made and entered into on the day of, 2012 by and between SELECT INSURANCE MARKETS, LP., a Texas Company ("SIM") and the following named individual or agency who/which
More informationInstructions for Completing the Customs Power of Attorney
Instructions for Completing the Customs Power of Attorney 1. Check the box that describes the status of your business. Foreign Company - Check the "Corporation" box. 2. Enter your Federal Tax ID number
More informationInstructions for Completion of the Customs Power of Attorney
Instructions for Completion of the Customs Power of Attorney 1. Click on the area above the blanks in the following form and enter your information. Be sure to include your company s EIN/IRS-Federal Tax
More informationWrite-Your-Own (WYO) Flood Insurance Program Agency Enrollment Form
Write-Your-Own (WYO) Flood Insurance Program Agency Enrollment Form Please complete the information below in order to sell flood insurance through The Main Street America Group s WYO Flood Insurance Program.
More informationPRODUCER AGREEMENT. Hereinafter ("Producer"), in consideration of the mutual covenants and agreements herein contained, agree as follows:
PRODUCER AGREEMENT Hereinafter First Choice Insurance Intermediaries, Inc "FCII", a Florida company, having an office at 814 A1A North, Suite 206, Ponte Vedra Beach, FL 32082 and " Producer" having an
More informationKansas Credit Services Organization Instructions for Application of Registration
STATE OF KANSAS OFFICE OF THE STATE BANK COMMISSIONER CONSUMER AND MORTGAGE LENDING DIVISION 700 SW Jackson St., Suite 300 Topeka, Kansas 66603-3796 785-296-2266 Fax: 785-296-6037 Kansas Credit Services
More informationBanner Life Insurance Licensing Checklist
Banner Life Insurance Licensing Checklist Please complete the following contracting papers. Remember to sign in the required areas. The more complete the application, the sooner it will be approved. Agents
More informationBROKERAGE AGREEMENT. This Brokerage Agreement (the Agreement ) is made and entered into by and between
BROKERAGE AGREEMENT This Brokerage Agreement (the Agreement ) is made and entered into by and between Broker Name & Address: (the Broker ) and P. E. Brokerage 105 Montgomery Ave PO Box 249 Montgomeryville,
More informationSafehold shall provide to Retailer insurance placement services as described herein:
Agency Resources a division of Safehold Special Risk THIS AGREEMENT is made effective this day of, 20 by and between Safehold Special Risk, Inc.( Safehold ) having an address located at 400 Interstate
More informationANTHEM BCBS OF KENTUCKY CONTRACTING INSTRUCTIONS
ANTHEM BCBS OF KENTUCKY CONTRACTING INSTRUCTIONS (PLEASE FOLLOW CAREFULLY) 1. Please print the following contract. 2. Complete the MedLink Agent Profile completely. 3. Date, fill out, and sign the Independent
More informationBROKER PROFILE. Name of Agency/Broker: Headquarters Location Street Address: Mailing Address. Main Contact for Agency:
BROKER PROFILE This form is used only if we bind coverage. It is due within 15 days after you receive notification of our intent to provide coverage. You may submit business for review and quotation without
More informationThank you for your interest in becoming a broker for the Counter Products offered through Sonoran National!
BROKER PACKET Thank you for your interest in becoming a broker for the Counter Products offered through Sonoran National! Once we receive the completed Broker Questionnaire, along with a copy of your current
More informationFARMERS MUTUAL INSURANCE ASSOCIATION OF BURNET COUNTY (FMBC) Agency Agreement
FARMERS MUTUAL INSURANCE ASSOCIATION OF BURNET COUNTY (FMBC) Agency Agreement Name of Agency: Social Security Number or Federal Tax ID Number: Agent Number: Agreement between (Agent/Agency), located in,
More informationSUBCONTRACTOR BUSINESS ASSOCIATE ADDENDUM
SUBCONTRACTOR BUSINESS ASSOCIATE ADDENDUM This Subcontractor Business Associate Addendum (the Addendum ) is entered into this day of, 20, by and between the University of Maine System, acting through the
More informationInvestment Advisory Agreement. This Investment Advisory Agreement is entered into [DATE] by [CLIENT NAME],
Investment Advisory Agreement This Investment Advisory Agreement is entered into [DATE] by [CLIENT NAME], whose mailing address is (hereinafter referred to as the CLIENT ), and Huckleberry Capital Management,
More informationI N S U R A N C E UNDERWRITERS PRODUCER APPOINTMENT PACKAGE
I N S U R A N C E UNDERWRITERS PRODUCER APPOINTMENT PACKAGE UNDERWRITERS INSURANCE Appointment Packet CHECKLIST PACKET CONTENTS INCLUDE Windhaven Underwriters Producer Agreement Form Windhaven Underwriters
More informationUS Assure Insurance Services of Florida, Inc.
US Assure Insurance Services of Florida, Inc. PRODUCER AGREEMENT THIS AGREEMENT is made and entered into as of the date hereof ( the Effective date ), by and between US Assure Insurance Services of Florida,
More informationNASDAQ Futures, Inc. Off-Exchange Reporting Broker Agreement
2. Access to the Services. a. The Exchange may issue to the Authorized Customer s security contact person, or persons (each such person is referred to herein as an Authorized Security Administrator ),
More informationWISCONSIN WEALTH ADVISORS, LLC WEALTH MANAGEMENT SERVICES AGREEMENT. This Agreement for wealth management services is made between
WISCONSIN WEALTH ADVISORS, LLC WEALTH MANAGEMENT SERVICES AGREEMENT This Agreement for wealth management services is made between ( Client ) and Wisconsin Wealth Advisors, LLC ( Adviser ). Client hereby
More informationCUSTOMS POWER OF ATTORNEY/DESIGNATION AS EXPORT FORWARDING AGENT and Acknowledgement of Terms and Conditions
, OTI# 020585NF Tel/Fax.800.721.2540 3322 36 th ave South, Seattle, WA 98144, USA CUSTOMS POWER OF ATTORNEY/DESIGNATION AS EXPORT FORWARDING AGENT and Acknowledgement of Terms and Conditions Appropriate
More informationNGL Contracting Checklist
NGL Contracting Checklist Please submit the following information and documents to SMS when licensing with NGL: Completed and Signed Contracting Agreement Completed and Signed NGL Advance Selection form
More informationExpanded Market Programs
Expanded Market Programs Empowering you to say Yes more often! Ivantage and NEA are affiliates of Allstate, who offer Exclusive Agents access to additional products for risks outside of Allstate s market
More informationSECTION I. Appointment, Activities, Authority and Status of REPRESENTATIVE
CAPITAL FINANCIAL SERVICES, INC. REPRESENTATIVE'S AGREEMENT This Agreement is executed in duplicate between Capital Financial Services, Inc., a Wisconsin corporation (hereinafter "COMPANY"), and the Sales
More informationCONSULTANT SERVICES AGREEMENT
CONSULTANT SERVICES AGREEMENT THIS AGREEMENT ( Agreement ) is made and entered into this 20 th day of December, 2012, by and between the City of Rio Vista, a municipal corporation of the State of California
More information2016 Pizza Hut BOOK IT! Grant Agreement
2016 Pizza Hut BOOK IT! Grant Agreement Thank you for partnering with The BOOK IT! Program of Pizza Hut ( Grantor ), to enable access to reading resources and improve literacy, empower teachers to improve
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is entered into this day of, 20, by and between ( Covered Entity ) and the University of Maine System, acting through the
More informationWHOLESALE BROKER AGREEMENT. THIS WHOLESALE BROKER AGREEMENT (this Agreement ) dated as of the
WHOLESALE BROKER AGREEMENT THIS WHOLESALE BROKER AGREEMENT (this Agreement ) dated as of the day of,, by and among the entities indicated on Schedule A attached hereto and incorporated herein by reference
More informationTERMS AND CONDITIONS REGARDING SERVICES RENDERED BY INTERNATIONAL WAREHOUSE SERVICES, INC.
TERMS AND CONDITIONS REGARDING SERVICES RENDERED BY INTERNATIONAL WAREHOUSE SERVICES, INC. THE FOLLOWING TERMS AND CONDITIONS, UPON YOUR ACCEPTANCE AS PROVIDED HEREIN, SHALL CONSTITUTE A LEGALLY BINDING
More informationProducer Agreement DDWA Product means an Individual or Group dental benefits product offered by Delta Dental of Washington.
Producer Agreement This agreement, effective the day of is between DELTA DENTAL OF WASHINGTON, referred to as DDWA in this agreement, and, referred to as Producer in this agreement. In consideration of
More informationMASTER BROKERAGE AGREEMENT
MASTER BROKERAGE AGREEMENT This agreement dated, is between, (hereinafter called BROKER ) and Maury Donnelly & Parr, Inc., 24 Commerce Street Baltimore, MD 21202 (hereinafter called MDP ). Whereas, the
More informationSELLING AGENT AGREEMENT SIGNATURE PAGE
SELLING AGENT AGREEMENT SIGNATURE PAGE The following AGREEMENT made between the Selling Agent identified below ("Selling Agent") and EmblemHealth Services Company LLC., on behalf of its licensed health
More informationCOBRA Setup Fact Sheet for Oswald agent
COBRA Setup Fact Sheet for Oswald agent NEO provides full-service administration of COBRA compliance obligations. Once set-up is complete, the employer simply notifies NEO after they commence or terminate
More informationBROKER AND BROKER S AGENT COMMISSION AGREEMENT
BROKER AND BROKER S AGENT COMMISSION AGREEMENT Universal Care BROKER AND BROKER S AGENT COMMISSION AGREEMENT This BROKER AND BROKER S AGENT COMMISSION AGREEMENT (this "Agreement") is made and entered
More informationPower of Attorney for Customs and Forwarding Agent and Acknowledgement of Terms and Conditions of Service
Power of Attorney for Customs and Forwarding Agent and Acknowledgement of Terms and Conditions of Service Copyright 1995, National Customs Brokers and Forwarders Association of America, Inc. (Revised 1/00)
More informationNSS Life Licensing Checklist
NSS Life Licensing Checklist Please complete the following contracting papers. Remember to sign in the required areas. The more complete the application, the sooner it will be approved. Agents Name: Appointing
More informationPlease Send the Completed form to: SIU Marketing Department Attn: Meagan Pind
Georgia Southern Insurance Underwriters Inc. appreciates your interest in contracting with us. Please review the Producer agreement and complete the attached forms and checklist before submitting. Please
More informationGROUP HEALTH INCORPORATED SELLING AGENT AGREEMENT
GROUP HEALTH INCORPORATED SELLING AGENT AGREEMENT This Agreement, made between Group Health Inc., having its principal office at 55 Water Street, New York, NY 10041 ("GHI"), and, having its principal office
More informationADEA Property Management Co 2527 S. 3 rd W., Missoula, MT office
ADEA Property Management Co 2527 S. 3 rd W., Missoula, MT 59804 office 406.728.2332 rentals@adeapm.com In consideration of the covenants herein contained of, hereinafter called "Owner" and David C. Armerding,
More informationORIGINATOR AGREEMENT
ORIGINATOR AGREEMENT This agreement is made the day of, 20, by and between BERKSHIRE LENDING, LLC, a Texas limited partnership ( Berkshire Lending ), with offices at 8848 Greenville Avenue, Dallas, Texas
More informationPRODUCER AGREEMENT R E C I T A L S
PRODUCER AGREEMENT This Producer Agreement (this "Agreement") is entered into by and between CAREINGTON International Corporation, a Texas corporation ("CAREINGTON"), and the undersigned ("Producer") and
More information1ST NORTHERN CALIFORNIA CREDIT UNION MOBILE REMOTE DEPOSIT CAPTURE AGREEMENT
1ST NORTHERN CALIFORNIA CREDIT UNION MOBILE REMOTE DEPOSIT CAPTURE AGREEMENT This Mobile Remote Deposit Capture Agreement ( Agreement ) contains the terms and conditions for the mobile remote deposit capture
More informationCboe Global Markets Subscriber Agreement
Cboe Global Markets Subscriber Agreement Vendor may not modify or waive any term of this Agreement. Any attempt to modify this Agreement, except by Cboe Data Services, LLC ( CDS ) or its affiliates, is
More informationSECTION III: SAMPLE CONTRACT AGREEMENT FOR SERVICES
SECTION III: SAMPLE CONTRACT AGREEMENT FOR SERVICES THIS AGREEMENT made and entered by and between the City of Placerville, a political subdivision of the State of California (hereinafter referred to as
More informationINSTRUCTIONS SHEET (Please return a copy of this form with your Dealer Standards)
INSTRUCTIONS SHEET (Please return a copy of this form with your Dealer Standards) Welcome to Sheffield Financial. We look forward to your business. Sheffield Financial has a three step Dealer set up process
More informationDear Producer: Best regards, Seth Johnson Chief Operating Officer Atlantic Specialty Lines. Non Account Current Agreement Page 1 of 4 Initial here
Dear Producer: Attached please find a copy of the Producer s Agreement we are using for all agencies that place business with Atlantic Specialty Lines on a Non Account Current status. This agreement formalizes
More informationAGENT / BROKER INFORMATION
(FOR INTERNAL USE ONLY) (Please Print) BROKER NUMBER: BROKER REGION CODE: COMMISSION AGREEMENT DATE: AGENT / BROKER INFORMATION (ALL INFORMATION IS REQUIRED TO PROCESS COMMISSION PROPERLY) LICENSED AGENT
More informationNon-Discretionary Investment Advisory Agreement Pennsylvania
Quantum Financial Advisors A Money And Wealth Management Firm Non-Discretionary Investment Advisory Agreement Pennsylvania QUANTUM FINANCIAL ADVISORS A comprehensive financial services and wealth management
More informationPSA COLLECTORS CLUB AGREEMENT
Rev. 07/25/11 Page 1 PSA COLLECTORS CLUB AGREEMENT This PSA Collectors Club Agreement (the Agreement ) is between you ( Customer ) and Collectors Universe, Inc., a Delaware corporation d/b/a Professional
More informationBCK Partners, Inc. COMPREHENSIVE FINANCIAL MANAGEMENT AGREEMENT
BCK Partners, Inc. COMPREHENSIVE FINANCIAL MANAGEMENT AGREEMENT AGREEMENT, made this day of 20, between the undersigned party (hereinafter referred to as the Client or You ) and BCK Partners, Inc., a Registered
More informationH. R. KELLER & CO., INC SHERIDAN DRIVE, BUFFALO, NY 14217
H. R. KELLER & CO., INC. 1520 SHERIDAN DRIVE, BUFFALO, NY 14217 (716) 874-1644 (800) 424-2202 FAX: (716) 874-4920 www.kellerco.com Dear Agency Principal, We appreciate your interest in placing business
More informationReferral Network, LLC (RNI) Referral Independent Contractor Agreement
Referral Network, LLC (RNI) Referral Independent Contractor Agreement The parties to this agreement are REFERRAL ASSOCIATE & REFERRAL NETWORK, LLC Please print, sign and return to the office I. INTRODUCTION
More informationINDEPENDENT CONTRACTOR AGREEMENT
INDEPENDENT CONTRACTOR AGREEMENT This Agreement is made on this day of, 20, between Coordinated Capital Securities, Inc. ("Company") and ( RR ). Section 1: Appointment 1.1 The Company hereby appoints the
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT This Agreement dated as of is made by and between, on behalf of its (School/Department/Division) (hereinafter referred to as Covered Entity ) and, (hereinafter Business Associate
More informationSTETSON UNIVERSITY CONSULTANT / INDEPENDENT CONTRACTOR AGREEMENT
STETSON UNIVERSITY CONSULTANT / INDEPENDENT CONTRACTOR AGREEMENT THIS AGREEMENT made and entered into this day of, by and between STETSON UNIVERSITY, INC., a Florida non-profit corporation, hereinafter
More informationPORTFOLIO MANAGEMENT AGREEMENT
PORTFOLIO MANAGEMENT AGREEMENT THIS PORTFOLIO MANAGEMENT AGREEMENT (this Agreement ) is effective as of November, 2018 (the Effective Date ), by and among CIC MEZZANINE INVESTORS, L.L.C., an Illinois limited
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (the Agreement ) is entered into this day of, 20, by and between the University of Maine System acting through the University of ( University
More informationWHOLESALE BROKER/CONTRACTOR AGREEMENT
WHOLESALE BROKER/CONTRACTOR AGREEMENT THIS WHOLESALE BROKER/CONTRACTOR AGREEMENT is entered into as of by and between Bondcorp Realty Services, Inc. ("Lender"), and, A CORPORATION ( Broker/Contractor ),
More informationChoice Fund Program (Russell Investments)
Choice Fund Program (Russell Investments) CLIENT SERVICES AGREEMENT FOR MUTUAL FUND WRAP ACCOUNT(S) This Kovack Advisors Choice Advisor Client Services Agreement ( Agreement ), is made and entered into
More informationDOWNEY FEDERAL CREDIT UNION MOBILE CHECK DEPOSIT/REMOTE DEPOSIT CAPTURE AGREEMENT
DOWNEY FEDERAL CREDIT UNION MOBILE CHECK DEPOSIT/REMOTE DEPOSIT CAPTURE AGREEMENT This Mobile Remote Deposit Capture Agreement ( Agreement ) contains the terms and conditions for the mobile remote deposit
More informationPOWER OF ATTORNEY/ DESIGNATION OF EXPORT FORWARDING AGENT And Acknowledgement of Terms and Conditions. Account Executive:
POWER OF ATTORNEY/ DESIGNATION OF EXPORT FORWARDING AGENT And Acknowledgement of Terms and Conditions Legal status of issuing party Check appropriate box Individual Partnership Corporation Sole Proprietorship
More informationFiscal Sponsorship Agreement
Fiscal Sponsorship Agreement Program Account Name: Account #: Date: Program Manager Name: Address: Email: Phone Number: Please initial each page certifying that you agree with and understand the terms
More informationTerms & Conditions of Service
Terms & Conditions of Service These terms and conditions of service constitute a legally binding contract between the "Company" and the "Customer". In the event the Company renders services and issues
More informationAGENTSECURE PRODUCER AGREEMENT
AGENTSECURE PRODUCER AGREEMENT Parties to this Agreement are the Agency Owner and Agency Principal [Enter Owner(s) Legal Entity and Principal(s)] (Producer) and Insurezone.com of Texas, Inc. d/b/a AgentSecure
More informationINDEPENDENT CONTRACTOR AGREEMENT (STATUTORY W-2)
INDEPENDENT CONTRACTOR AGREEMENT (STATUTORY W-2) THIS INDEPENDENT CONTRACTOR AGREEMENT is made and entered into on, by and between WARDLAW INSURANCE SERVICES, INC., a Texas Limited Liability Company, hereinafter
More informationGeneral Agent Contract
General Agent Contract This is a General Agent (GA) Contract between the GA referred to below (the "GA", "You" or "Your) and The Baltimore Life Insurance Company (the "Company"). I. AGREEMENT The GA agrees
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is entered into this day of, 20, by and between the University of Maine System ( University ), and ( Business Associate ).
More informationIndependent Contractor Agreement (Between X Agents Refer Hereafter Broker and Associate Licensee)
Independent Contractor Agreement (Between X Agents Refer Hereafter Broker and Associate Licensee) This agreement, dated, is made between X Agents Refer ( Broker ) and ( Associate Licensee ). In consideration
More informationFedNat Underwriters PO Box Ft. Lauderdale, FL Phone: (800) (option 3) Fax: (954)
AGENCY QUESTIONNAIRE Thank you for your interest in representing FedNat Insurance Company / Monarch National Insurance Company and other nationally recognized insurance companies. Please complete the questionnaire
More informationINDEPENDENT CONTRACTOR AGREEMENT (ICA)
INDEPENDENT CONTRACTOR AGREEMENT (ICA) (This agreement is not a construction contract within the meaning of Civil Code section 2783, and is not an agreement for the provision of construction services within
More informationCarrier Agreement Packet
Revision 12/8/2017 02:17PM Carrier Agreement Packet Information carrier must submit to broker: 1) Completed W-9 (must be Revision 2014 or Later) 2) Copy of Carrier Transport Authority 3) Certificate of
More informationBSP HCMC Branch Internet Banking Personal Purpose Account Terms and Conditions
BSP HCMC Branch Internet Banking Personal Purpose Account Terms and Conditions This document describes the terms and conditions (these Terms and Conditions ) that apply to a personal purpose account that
More informationWright National Flood Insurance Services, LLC th Avenue North, Suite 110 St. Petersburg, FL (hereinafter referred to as "WNFIS )
PARTIES TO THIS AGREEMENT V1116S Wright National Flood Insurance Services, LLC 801 94 th Avenue North, Suite 110 St. Petersburg, FL 33702 (hereinafter referred to as "WNFIS ) Producer Name: Address: City,
More informationBUSINESS ASSOCIATE AGREEMENT W I T N E S S E T H:
BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( this Agreement ) is made and entered into as of this day of 2015, by and between TIDEWELL HOSPICE, INC., a Florida not-for-profit corporation,
More informationSMALL GROUP MASTER CONTRACT
McLAREN HEALTH PLAN, INC. G-3245 Beecher Road Flint, MI 48532 SMALL GROUP MASTER CONTRACT GROUP: EFFECTIVE DATE: McLaren Health Plan, Inc. ( Plan ), a Michigan health maintenance organization, and the
More informationINVESTMENT ADVISORY AGREEMENT
INVESTMENT ADVISORY AGREEMENT 1150 Bob Courtway Dr. Suite 50 Conway, AR 72032 This Investment Advisory Agreement made and entered into this Day of,20 by (Client). Client hereby agrees to engage Veritas
More information