Please return these documents along with a copy of your current E&O coverage and a W-9 used for commission purposes.

Transcription

1 To: All of KRFSIF s Valued Agents Re: Independent Insurance Agency Producer Agreements Dear Agent: Cannon Cochran Management Services Inc. (CCMSI) provides claims, underwriting, and loss control services for the Kentucky Retail Federation Self Insurers Fund (KRFSIF). In order to update the Agency files, it is necessary that a producer agreement be executed between your agency and CCMSI. KRFSIF values our relationship with your agency, and we look forward to doing business with you for years to come. In addition, we trust that you recognize the value you have received from KRFSIF in the form of our dedication to service and a flat 10% commission with no production minimums. You are an integral part of our future and we would like to be a part of yours as well. We ask that you please review and sign the enclosed Agency Questionnaire and two Master Agency Agreements (One of the original Master Agency Agreements will be returned to you, once Mr. Golden has signed it.) Please return these documents along with a copy of your current E&O coverage and a W-9 used for commission purposes. If you have any questions, comments or concerns, please feel free to contact me any time at Sincerely, Mary Carney CCMSI/KRFSIF Account Manager

2 CCMSI Representative: AGENCY QUESTIONNAIRE Information contained in this questionnaire may be used to secure Dun & Bradstreet or other credit rating Agency Name: Contact Name & Title: Street Address: Mailing Address: City: State: Zip Code: Phone Number: Ext: Fax Number: Federal Tax ID Number: List the States that you Agency is Licensed: List of Individuals Producing Business with CCMSI (Please identify if individual is agent or broker) Name: (A) Agent or (B) Broker Name: (A) Agent or (B) Broker

3 AGENCY ERRORS & OMISSIONS INSURANCE IMPORTANT: this questionnaire: Please provide E & O Certificate copy when submitting Check if you have none AGENCY REGISTRATION & PROCEDURES LICENSE IMPORTANT: Please provide a copy of your Agency Registration and current copies of all Producers Resident License when submitting this questionnaire (if applicable) Check if you have none Completed By: Name & Title Signature Date

4 MASTER AGENCY AGREEMENT Whereas Cannon Cochran Management Services, Inc. (herein referred to as CCMSI )and (hereinafter referred to as Agency ) wish to enter into this Agency Agreement concerning certain Marketing responsibilities to the Clients of the Program. CCMSI and the Agency agree to the following terms and conditions: Effective Date of This Agreement: Client: Kentucky Retail Federation Self-Insurers Fund Authority of Agency: Agency is not authorized and is expressly forbidden on behalf of CCMSI to incur any indebtedness or liability or to make, alter or discharge contracts, to waive policy provisions, make extra rates, extend the time of any contribution and/or fee, extend the valid dates of any proposals, or receive any money due to CCMSI (received by CCMSI on behalf of the Kentucky Retail Federation Self-Insurers Fund). Agency Responsibilities: Agency s primary responsibilities include the development and sale of new business, as well as the delivery and explanation of the renewal proposal of the Clients. Agency warrants it understands the Program s financial and underwriting guidelines and procedures concerning new and renewal business and will deliver all necessary prospect information to CCMSI for the timely submission of information to and final decision of the Client. Fees: Agency will receive a percentage of the contribution of the Client (see attached Schedule A). This marketing fee shall be payable by CCMSI to the Agency as the contribution/fees are received by CCMSI subject to any deductions there from that maybe required due to indebtedness to CCMSI. Payments shall be disbursed on a quarterly basis and based upon contributions and/or fees that are due and payable to the prior quarter. Agency not Assignable: This Agreement shall not be assigned or transferred either in whole or in part, without the written consent of Kentucky Retail Federation Self-Insurers Fund and the Client. Errors and Omissions: Agency agrees to furnish a copy of their errors and omissions coverage to CCMSI. Said coverage shall be maintained at a minimum of $1,000,000. Further, Agency agrees to furnish CCMSI all amendments and/or endorsements pertaining to such coverage and will provide a certificate of coverage upon request.

5 Indemnity Agreement: Agency hereby agrees to save, indemnify and hold harmless CCMSI from any and all liabilities of any kind or nature whatsoever, whether fixed, contingent, liquidated or unliquidated occurring or arising prior to the date of this Agreement, in connection with the management, conduct or operations of Agency s business. During and after this Agreement, Agency agrees to save, indemnify and hold harmless CCMSI from any and all claims or liabilities of any kind or nature whatsoever, including reasonable attorney s fees incurred by CCMSI or the Client, as a result of misconduct, errors or omissions of Agency or its employees or affiliates in connection with the performance of this agreement. CCMSI hereby agrees to save, indemnify and hold harmless Agency from any and all liabilities of any kind or nature whatsoever, whether fixed, contingent, liquidated or unliquidated occurring or arising prior to the date of this Agreement, in connection with the management, conduct or operations of CCMSI s business. Termination: This Agreement will terminate upon termination of the service agreement between CCMSI, and Kentucky Retail Federation Self-Insurers Fund, or immediately for any act of dishonesty or fraud, or in the event of any of the following: A. Upon termination of the Program. B. For any act of dishonesty or fraud. C. The Agency s State license(s) necessary to engage in the insurance business are not in full force and effect. D. The Agency ceases doing business as a going concern, becomes insolvent, makes any assignment for the benefit of creditor, or takes advantage of any law for the relief of debtors; E. The Agency is acquired or merged into another business entity, unless prior written consent is secured from Client and Kentucky Retail Federation Self-Insurers Fund. F. Cancellation or non-renewal of Agency s E&O Coverage. In the event the Client named herein names a different agency through an Agency of Record letter, the Agency will be given ten (10) days written notice prior to the Agency of Record letter becoming effective in order for the Agency to be given an opportunity to obtain a rescinding letter. Upon the effective date of such Agency of Record letter, Agency s rights under this contract, including the rights to any fees (except earned but unpaid commission) shall thereupon cease. Agency will have no rights to future commissions due for the balance of the year or rights to renewals.

6 Amendments: No oral promises or representations shall be binding. No waiver or modification of this Agreement shall be effective unless it be in writing and signed by a duly authorized officer of CCMSI and the Agency. Executed this day of, CANNON COCHRAN MANAGEMENT SERVICES, INC. By: Its: Executive Vice President & CMO AGENCY NAME: By: Print: Its:

7 MASTER AGENCY AGREEMENT Whereas Cannon Cochran Management Services, Inc. (herein referred to as CCMSI )and (hereinafter referred to as Agency ) wish to enter into this Agency Agreement concerning certain Marketing responsibilities to the Clients of the Program. CCMSI and the Agency agree to the following terms and conditions: Effective Date of This Agreement: Client: Kentucky Retail Federation Self-Insurers Fund Authority of Agency: Agency is not authorized and is expressly forbidden on behalf of CCMSI to incur any indebtedness or liability or to make, alter or discharge contracts, to waive policy provisions, make extra rates, extend the time of any contribution and/or fee, extend the valid dates of any proposals, or receive any money due to CCMSI (received by CCMSI on behalf of the Kentucky Retail Federation Self-Insurers Fund). Agency Responsibilities: Agency s primary responsibilities include the development and sale of new business, as well as the delivery and explanation of the renewal proposal of the Clients. Agency warrants it understands the Program s financial and underwriting guidelines and procedures concerning new and renewal business and will deliver all necessary prospect information to CCMSI for the timely submission of information to and final decision of the Client. Fees: Agency will receive a percentage of the contribution of the Client (see attached Schedule A). This marketing fee shall be payable by CCMSI to the Agency as the contribution/fees are received by CCMSI subject to any deductions there from that maybe required due to indebtedness to CCMSI. Payments shall be disbursed on a quarterly basis and based upon contributions and/or fees that are due and payable to the prior quarter. Agency not Assignable: This Agreement shall not be assigned or transferred either in whole or in part, without the written consent of Kentucky Retail Federation Self-Insurers Fund and the Client. Errors and Omissions: Agency agrees to furnish a copy of their errors and omissions coverage to CCMSI. Said coverage shall be maintained at a minimum of $1,000,000. Further, Agency agrees to furnish CCMSI all amendments and/or endorsements pertaining to such coverage and will provide a certificate of coverage upon request.

8 Indemnity Agreement: Agency hereby agrees to save, indemnify and hold harmless CCMSI from any and all liabilities of any kind or nature whatsoever, whether fixed, contingent, liquidated or unliquidated occurring or arising prior to the date of this Agreement, in connection with the management, conduct or operations of Agency s business. During and after this Agreement, Agency agrees to save, indemnify and hold harmless CCMSI from any and all claims or liabilities of any kind or nature whatsoever, including reasonable attorney s fees incurred by CCMSI or the Client, as a result of misconduct, errors or omissions of Agency or its employees or affiliates in connection with the performance of this agreement. CCMSI hereby agrees to save, indemnify and hold harmless Agency from any and all liabilities of any kind or nature whatsoever, whether fixed, contingent, liquidated or unliquidated occurring or arising prior to the date of this Agreement, in connection with the management, conduct or operations of CCMSI s business. Termination: This Agreement will terminate upon termination of the service agreement between CCMSI, and Kentucky Retail Federation Self-Insurers Fund, or immediately for any act of dishonesty or fraud, or in the event of any of the following: A. Upon termination of the Program. B. For any act of dishonesty or fraud. C. The Agency s State license(s) necessary to engage in the insurance business are not in full force and effect. D. The Agency ceases doing business as a going concern, becomes insolvent, makes any assignment for the benefit of creditor, or takes advantage of any law for the relief of debtors; E. The Agency is acquired or merged into another business entity, unless prior written consent is secured from Client and Kentucky Retail Federation Self-Insurers Fund. F. Cancellation or non-renewal of Agency s E&O Coverage. In the event the Client named herein names a different agency through an Agency of Record letter, the Agency will be given ten (10) days written notice prior to the Agency of Record letter becoming effective in order for the Agency to be given an opportunity to obtain a rescinding letter. Upon the effective date of such Agency of Record letter, Agency s rights under this contract, including the rights to any fees (except earned but unpaid commission) shall thereupon cease. Agency will have no rights to future commissions due for the balance of the year or rights to renewals.

9 Amendments: No oral promises or representations shall be binding. No waiver or modification of this Agreement shall be effective unless it be in writing and signed by a duly authorized officer of CCMSI and the Agency. Executed this day of, CANNON COCHRAN MANAGEMENT SERVICES, INC. By: Its: Executive Vice President & CMO AGENCY NAME: By: Print: Its:

10 SCHEDULE A Effective Date Client Name of Client Contribution