About Us! The Clear Solution For Your Auto Insurance Needs.
|
|
- Spencer Darcy Long
- 5 years ago
- Views:
Transcription
1 About Us! ClearSide General specializes in Personal Lines Automobile coverage. Our philosophy is to provide a select group of agents an exclusive opportunity to do business with an organization that values the company-agent relationship. We offer quality programs with the innovation and personalized service you need to be successful. President & CEO Byron Storms had a Clear Vision when establishing ClearSide. Build a General Agency designed to service the needs of the agent community, with a personal touch that is missing in today s marketplace. ClearSide General has exclusive agreements with financially sound carriers including GMAC Insurance rated A- (Excellent), and AmTrust rated A (Excellent) by A.M. Best Company, the most widely know and respected independent insurance rating and information service. For the latest A.M. Best Rating, access Our systems, technology, operating platform and unique marketing strategy will provide our brokers and policyholders with competitive products, quality customer service and ease of use they expect and deserve. The Clear Solution For Your Auto Insurance Needs.
2 New Appointment Checklist Date Check 1) Producer Application 2) Producer s Agreement 3) W-9 Form 4) EFT Authorization Form with a voided check 5) License-Expiration Date 6) E & O Dec. Page (Min. limit $300,000)-Expiration Date 7) Agency Management System (if applicable) 8) Comparative Rater (if applicable) Please submit these documents to ClearSide General PO Box 606 Rancho Cucamonga, CA PH: (909) FX: (909) License No. 0G67839
3 PRODUCER APPLICATION Producer Information 1. Business Name (DBA): Contact Name & Title 2. Mailing Address: City: State: Zip: 3. Physical Address (if different than mailing): 4. Phone: ( ) - 5. Fax: ( ) - 6. General 7. Owners 8. Website: 9. Principal, Partner and or Corporate Office: Principal Name: Title: Home Address: City: State: ZIP: Home Phone / Cell Number: ( ) - SSN #: Lic#: 10: Incorporated: Y or N Type: Corp. LLC Sole Proprietor Partnership FEIN: Questions (Circle) 1. Have you or your firm ever been named in any suit? Yes No 2. Have you or your firm ever filed for bankruptcy? Yes No 3. Have you or your firm ever been investigated by the Department of Insurance? Yes No 4. Have you ever been convicted of a criminal felony? Yes No 5. If convicted of a criminal felony, was it reported to the Dept. of Insurance Yes No 6. Have you had a contract cancelled or denied? Yes No 7. How many years in business? 8. Number of locations? (Please attach a list containing each office address, licensed producer, and contact info.)
4 Top Carriers Represented Company Name YTD Written Premium PIF License Information Complete for all licensed producers that will be writing business for ClearSide General. Please include a copy of a Producer s license for each branch location: Producer Name: Title or Position: Home Address: City: State: Zip: Social Security Number: Date of Birth: Home Phone # Resident License Number: Exp Date: ***I HEREBY AUTHORIZE CLEARSIDE GENERAL TO OBTAIN A BACKGROUND CHECK REPORT AND I UNDERSTAND IT MAY CONTAIN INFORMATION ABOUT MY CREDIT WORTHINESS, CHARACTER, AND CRIMINAL HISTORY. x Producer Signature: I hereby acknowledge that the ClearSide General Insurance Services, LLC and/or its representatives, may from time to time, conduct personal, business, or financial credit or reference checks of the applicant, its owners, officers or licensed employees. I also certify that the information herein is true and accurate. Principal Signature Date
5 If you are a Sole-Proprietor, please list all licensed producers below: Producer Name License Number Social Security Number
6 Producer s Agreement This agreement made this day of, by ClearSide General Insurance Services, LLC. ( ClearSide ) and a retail insurance agency, ( Producer ). I. PRODUCER S AUTHORITY A. Producer is an independent contractor who will exercise its own judgment in the conduct of its business. Producer is not an employee of ClearSide and is free to represent such other companies as Producer shall consider appropriate. Producer has exclusive control of its time and of the conduct of its business and is responsible for all expenses incurred in the operation of its business. Producer agrees to be bound by all underwriting guidelines, rate guides, rules, regulations, commission schedules, procedures and other written policies or instructions provided to Producer by ClearSide ( ClearSide s Underwriting Guidelines ). B. The Company grants authority to the Producer to solicit and receive applications and downpayments for the classes of insurance coverages set forth in the Company s current programs and rate manuals, as amended or changed from time to time; subject, however, to Producer restrictions dictated by the laws of the state where the Producer is authorized to write insurance and to the terms and conditions specified in this Agreement. The Producer has the authority to receive applications for and bind such insurance coverages, and to collect, receive and receipt for downpayments and premiums for same. All applications and downpayments received by the Producer must be forwarded to the Company within the Producer s 72 hour binding authority. All requests for cancellations of policies, endorsements and other modifications of existing policies must be forwarded to the Company within the Producer s 72 hour binding authority. The Producer s authority to bind coverage is RESTRICTED as follows: 1. Authority is restricted to coverages regularly written by the Company. 2. The producer does not have authority to issue policies, endorsements or cancellation noticesunless specifically authorized to do so, in advance, in writing by the Company. 3. In no event may the Producer permit a broker or solicitor employed or engaged by the Producer to bind the Company. C. Producer agrees that all supplies furnished to Producer by ClearSide shall remain the property of ClearSide and shall be returned upon request. D. Producer hereby grants to ClearSide access and review of Producer s books, records and files during normal business hours, for the purpose of determining any fact relating to money due ClearSide or any other fact relating to business placed with ClearSide by Producer. E. Producer shall not publish or distribute any advertisements, circulars or other materials referring to ClearSide or containing ClearSide s name without first securing written approval from ClearSide. II. UNDERWRITING CONTROL OF THE COMPANY ClearSide reserves the right to refuse any policy at any time or to cancel any policy subject to the provisions of Section VI. III. COMMISSIONS A. Commissions may be revised by mutual agreement of Producer and ClearSide or by ClearSide giving Producer at least 30 days advance notice of the proposed revisions and the effective date. Producer acknowledges such right to amend and waives any longer notice period that may be available under applicable statutes, rules or regulations. Producer agrees that undistributed commissions in the hands of ClearSide at any time may be offset against any monies due ClearSide. B. In the event that ClearSide shall either during the term of this Agreement or after its termination refund premiums under any policy by reason of cancellation or otherwise, the Producer shall immediately return to ClearSide the commission received on the premium refund. IV. EXPIRATIONS AND RENEWALS A. Producer and ClearSide expressly recognize Producer s independent ownership of the policy expirations covered by this Agreement and Producer shall retain ownership of these expirations during and after the termination of this Agreement so long as Producer has fulfilled its obligations under this Agreement. Producer hereby assigns to ClearSide as security for its obligation to pay ClearSide, but not in payment, all sums due or to become due to Producer from the insured or insureds for whom such Policies were produced by Producer for ClearSide and with full authority in ClearSide to demand and collect these sums. On premiums so collected by ClearSide, Producer shall be entitled to no commission. B. To further secure the payment, when due, of any and all sums which may become due ClearSide hereunder, Producer grants to ClearSide a security interest in the expirations and renewals of Policies procured through ClearSide, including the ownership,
7 exclusive use of same, and to have the rights of the holder of a security interest granted by law (including but not limited to the right of foreclosure) to effectuate this security interest; and Producer agrees to surrender peaceable possession of same to ClearSide on demand. C. Producer agrees that this Agreement or any copy thereof may be filed as a financing statement if ClearSide so elects. Producer hereby agrees to sign a UCC-1 Form and any other documents required to secure ClearSide s interest in the expirations and renewals. V. BILLING PROCEDURES A. Producer shall submit promptly to ClearSide all applications for policies and remit the gross premiums (without deduction of commissions) for or payable on such policies, in accordance with the provisions of ClearSide s Underwriting Guidelines. Producer shall be responsible for remitting all collected premiums to ClearSide. If Producer fails to remit premiums or earned commissions or any other amount due ClearSide, Producer agrees to pay the reasonable costs of collection, including attorney fees. B. ClearSide shall mail or deliver to Producer a copy of underwriting requests for cancellation or nonrenewal notices. C. Subject to the rights of Company under Section IV, ClearSide shall upon request of Producer following termination of this Agreement, supply Producer with a list of all policyholders, policy numbers and the expiration dates of the policies. VI. POLICY CANCELLATIONS VII. INDEMNIFICATION OF AGENT Any Policy may be cancelled by ClearSide, subject to any limitation or restrictions contained within the policy. A policy may be cancelled by ClearSide in accordance with all statutory and regulatory provisions. A. ClearSide shall indemnify and hold Producer harmless: 1. Against any claims, liabilities or costs of defense which Producer may become obligated to pay as a result of loss to policyholders caused by an error of ClearSide in the processing of policies under this Agreement unless Producer has caused, contributed to or compounded such error. 2. Against any and all civil liability for damages and expenses, including the cost of defense, that Producer may be obligated to pay as a direct result of the failure of ClearSide to comply with the requirements of the Fair Credit Reporting Act, Federal Truth in Lending Law and Fair Credit Billing Act, unless that such failure to comply has been caused or contributed to by any act or omission of Producer. B. ClearSide s obligation to indemnify shall be conditional upon prompt notification by Producer to ClearSide of any claim made or legal action brought against Producer which is subject to indemnification as set forth above and ClearSide shall have the right to direct the investigation, settlement and defense of any such claim or action. ClearSide shall not be obligated to indemnify Producer to the extent the Producer has valid and collectable insurance applicable to any damage or liability. VIII. INDEMNIFICATION OF CLEARSIDE Producer agrees to fully indemnify and hold harmless ClearSide, its successors and assigns from any and all judgments, losses, damages, costs and expenses, including attorney s fees which ClearSide may at any time sustain because of the failure of Producer to comply fully with the terms, provisions and obligations of this Agreement, including, but not limited to the payment to ClearSide of all sums of money which may become due ClearSide from Producer thereunder and any agreement to indemnify ClearSide. This Agreement to indemnify and hold ClearSide harmless shall include the reasonable attorney s fees and related expenses incurred to prosecute or defend any lawsuit, administrative proceeding or arbitration; shall extend to any claim or assertion that Producer breached or waived any provision of any policy, endorsement or application; and shall include any claims or assertions of bad faith, breach of covenant of fair dealing, unfair claims or insurance practices, deceptive trade practices, extracontractual or exemplary damages arising wholly, or in part, from the action or inaction of Producer. IX. TERMINATION AND AMENDMENT A. The agreement shall terminate: 1. Automatically if any public authority cancels or declines renewal of Producer s license or Certificate of Authority. 2. Automatically on the effective date of sale, transfer, assignment or merger of Producer s business provided, however, that ClearSide, at its option, may offer a Producer s Agreement to any successor who meets the Company s requirements for appointment. 3. Upon either party giving at least thirty (30) days advance written notice to the other. The provider acknowledges ClearSide s right to terminate and waives any longer notice period which may be available under applicable statues, rules or regulations.
8 4. Immediately upon either party giving written notice to the other in the event of abandonment, fraud, insolvency, or gross and willful misconduct on the part of such party. B. If this Agreement is terminated as provided in Sub-Section A3, above; 1. The Producer s authority to solicit, bind or execute contracts of insurance for new business will cease at the same time notice of termination of this Agreement is given. 2. All provisions of this Agreement shall remain in full force and effect including Section III, COMMISSIONS except that Producer agrees that after termination ClearSide may pay a commission rate less than the prevailing commission rate paid its active producers. 3. ClearSide shall continue to provide to the policyholders all normal and appropriate services on all in force insurance contracts without interruption until said contracts may lawfully be terminated. C. ClearSide may amend this Agreement, including any addendum attached hereto, upon thirty (30) days prior written notice to Producer. Producer acknowledges such right to amend and waives any longer notice period which may be available under applicable statutes, rules or regulations. X. GENERAL PROVISIONS A. Producer agrees to purchase and maintain a policy of errors and omissions insurance in limits no less than $500,000 with an insurance carrier which is rated no less than B by A.M. Best. Producer will provide ClearSide with a copy of the declarations page for said policy, and upon each renewal of said policy. Producer agrees that failure on the part of Producer to maintain said errors and omissions policy will be grounds for immediate termination of this contract. B. Producer agrees to immediately notify ClearSide in writing if producer is ever convicted of a criminal felony. C. ClearSide shall include all credits for salvage and subrogation recoveries on agency loss exhibits. D. Should a conflict exist as to which producer is authorized to represent an insured with respect to any insurance policy, Producer shall supply ClearSide with a written Agent of Record Letter from the insured. E. Producer shall have no authority to admit liability or compromise claims or accept proof of loss on the part of ClearSide in any manner except in accordance with specific claim settlement authority extended to the Producer in writing. F. Producer agrees to comply with all laws affecting its operation and to maintain its qualifications for licensing by appropriate authorities. G. If any provision of this Agreement should be invalid the remainder of this Agreement shall not be affected. H. If Producer attempts to assign this Agreement in violation of Section IX, Producer remains liable to ClearSide for all obligations to ClearSide arising before and after the attempted assignment. Moreover, Producer shall remain liable to ClearSide for all obligations to ClearSide arising before a permitted assignment, unless ClearSide has consented, in a written agreement, to the assumption of any obligation of Producer to ClearSide by an assignee. In connection with your application for a Producer s Agreement (1) an investigation may be made including, if applicable, information as to character, occupation, general reputation, personal habits, health, financial condition, mode of living, and (2) additional information as to the nature and scope of investigation request will be furnished you, upon your written request made within a reasonable time after you receive this notice.
9 In witness whereof, Producer and ClearSide have caused this Agreement to be executed this day of, 20. Producer: ClearSide General Insurance Services, LLC.: By: By: Print: Print: Byron Storms Title: Title: President & CEO Date: Date:
10
11 ELECTRONIC FUNDS TRANSFER (EFT) AND CHECK AUTHORIZATION AGREEMENT ClearSide General Insurance Services, LLC ( ClearSide ) is hereby authorized to present EFT items on the broker s account indicated below and the depository name below for payment and settlements due to ClearSide by the broker s or for payment of the settlements due to the broker by ClearSide. This arrangement does not affect producer s primary obligation for payment. This authorization is to remain in effect until ClearSide is notified to the contrary in writing. Bank Name Bank Phone Number Bank Name and Branch (or Main Office) (Street, City, State and Zip) Name/Title on Bank Account Checking Account Number Producer Name (DBA) Contact Person and Telephone Number Authorized Signature on Account ABA Routing Number ClearSide Producer Code Fax Number Date ATTACH VOIDED CHECK HERE
The Clear Solution For Your Auto Insurance Needs.
About Us! ClearSide General specializes in Personal Lines Automobile coverage. Our philosophy is to provide a select group of agents an exclusive opportunity to do business with an organization that values
Insurance Market Solutions Group, LLC Sub-Producer Agreement
Insurance Market Solutions Group, LLC Sub-Producer Agreement This Producer Agreement is made and entered into effective the day of, 20, by and between Insurance Market Solutions Group, LLC a Texas Company
Limited Agency/Company Agreement
Effective, this Agreement is entered into by and between Safepoint MGA, LLC and Safepoint Insurance Company Inc., hereinafter referred to as Company, and hereinafter referred to as Agent. It being the
TEXAS FAIR PLAN PRODUCER REQUIREMENTS AND PERFORMANCE STANDARDS
Producer Requirements Page 1 TEXAS FAIR PLAN PRODUCER REQUIREMENTS AND PERFORMANCE STANDARDS The following Texas FAIR Plan Association ( Association ) requirements and producer performance standards (
INSURANCE AGENCY AGREEMENT
INSURANCE AGENCY AGREEMENT BritAmerica Management Group, Inc., hereinafter referred to as the Company, hereby appoints: Agent Agency Address City State Zip Tax ID hereinafter referred to as the Agent.
HOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY
HOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY This Agreement is made and entered into effective as of October
INDEPENDENT PRODUCER AGREEMENT
INDEPENDENT PRODUCER AGREEMENT and AGENT PROFILE 1123 North Causeway Boulevard Mandeville, LA 70471 Phone: (985) 612-1230 Fax: (985) 612-1240 lciwc.com IMPORTANT: The information requested on this page
Agent Agreement WITNESSETH
PATRIOT NATIONAL UNDERWRITERS, INC. Agent Agreement THIS AGENT AGREEMENT (the Agreement ) is made and entered into by and between Patriot National Underwriters, Inc., a Texas corporation ( Patriot ), and
PREPARED 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,
BROKERAGE AGREEMENT. WHEREAS Broker wishes to gain access to and offer Paragon s specialized insurance products and services to its clients; and
BROKERAGE AGREEMENT This Agreement, effective 2014 is between Paragon Insurance Holdings, LLC ( Paragon ), 45 Nod Road, Avon, Connecticut 06001 with underwriting office at 850 Fulton Street, Farmingdale,
Insurance Producer Agreement
Insurance Producer Agreement Section 1 - Producer s Authority The Producer shall periodically submit risks to the Company for its consideration as authorized by the Company. These risks shall be located
NEW ERA LIFE INSURANCE COMPANY GENERAL AGENT S CONTRACT. For. Name. Address. City State Zip
NEW ERA LIFE INSURANCE COMPANY GENERAL AGENT S CONTRACT For Name Of Address City State Zip P.O. Box 4884 Houston, Texas 77210-4884 200 Westlake Park Blvd. Suite # 1200 Houston, Texas 77079 1-800-713-4680
WELCOME TO CABRILLO PACIFIC INSURANCE SERVICES, LLC
WELCOME TO CABRILLO PACIFIC INSURANCE SERVICES, LLC Dear Prospective Broker: Thank you for your interest in Cabrillo Pacific Insurance Services, LLC. At Cabrillo, we believe in delivering a quality product
CLS Investments, LLC Instructions for the Solicitor Application and Agreement
CLS Investments, LLC Instructions for the Solicitor Application and Agreement Please complete all fields on page 1 of the Solicitor Application and Agreement. Some general guidelines are set forth below.
Heritage Specialty Insurance Agency, LP Producer Agreement
Heritage Specialty Insurance Agency, LP Producer Agreement This Agreement effective, 20, is between Heritage Specialty Insurance Agency, LP (hereinafter described as Heritage ), and, (hereinafter described
AGREEMENT. Solicitor Without Per Diem Compensation
Solicitor Without Per Diem Compensation AGREEMENT Products underwritten by: American General Life Insurance Company Houston, Texas The United States Life Insurance Company in the City of New York New York,
TERMS OF BUSINESS AGREEMENT
TERMS OF BUSINESS AGREEMENT 2525 E Camelback Rd, Suite 800 As used in this Agreement, The Keating Group, Inc. (tkg) shall refer to any business unit or entity that may be affiliated through common ownership
Agent's Name Insurance Agency, LLC. Agent's Address is a party to this Agreement and is hereinafter called the "Agent".
AGENCY AGREEMENT The Company, designated as ABC Mutual Insurance Company, as now or hereafter constituted, its successors or assigns, is a party to this Agreement and is hereinafter referred to as "Company."
NATIONAL INSURANCE INTERMEDIARIES, INC. DIRECT ACCESS PRODUCER AGREEMENT
NATIONAL INSURANCE INTERMEDIARIES, INC. DIRECT ACCESS PRODUCER AGREEMENT THIS AGREEMENT ("Agreement"), dated is entered into by and between Orchid Underwriters Agency, Inc. ( Orchid ) located at: 1201
FACILITIES USE AGREEMENT
FACILITIES USE AGREEMENT Effective Date: Sponsor: Sponsor Address: Facility: THIS FACILITIES USE AGREEMENT ( Agreement ) is effective as of the Effective Date set forth above, by and between Temple University
A. TERM OF AGREEMENT.
PRODUCER AGREEMENT This Producer Agreement (this Agreement ) is made and entered into between Coastal Insurance Underwriters, Inc. ( Coastal ) and, (the Producer ). A. TERM OF AGREEMENT. This Agreement
AGENCY APPOINTMENT CONTRACT. Name of Agency. For Company Use Only. Agency Code No. Marketing Representative
AGENCY APPOINTMENT CONTRACT Name of Agency For Company Use Only Agency Code No. Marketing Representative AGENCY APPOINTMENT CONTRACT Thank you for your prior submission of the Agency Appointment Application
SOLICITOR APPLICATION
Date: / / SOLICITOR APPLICATION General Information Name: Birth Date: / / Office Address: City: State: Zip: E-mail address: Business phone: ( ) - Fax number: ( ) - Assistant s Name: Registered Investment
WELCOME. Thank you for your interest in representing A-One Commercial Insurance Risk Retention Group, Inc. (A-One).
WELCOME Thank you for your interest in representing A-One Commercial Insurance Risk Retention Group, Inc. (A-One). Attached you will find the necessary paperwork needed for your appointment. A brief checklist
BROKER AND CARRIER AGREEMENT
P.O. Box 889 394 NE Hemlock Redmond, OR 97756 BROKER AND CARRIER AGREEMENT All loads tendered by Central Oregon Truck Company ("Broker") and accepted for transportation by third party carriers ("Carrier")
FINANCIAL INSTITUTION AGREEMENT
Banner Life Insurance Company 3275 Bennett Creek Avenue Frederick, Maryland 21704 (800) 638-8428 FINANCIAL INSTITUTION AGREEMENT 1. Subject to the terms and conditions of this Agreement, the undersigned
GENERAL AGENT AGREEMENT
Complete Wellness Solutions, Inc. 6338 Constitution Drive Fort Wayne, Indiana 46804 GENERAL AGENT AGREEMENT This Agreement is made by and between Complete Wellness Solutions, Inc. (the Company ) and (the
DATE SIGNATURE OF AUTHORIZED REPRESENTATIVE/AGENT:
NATIONAL GUARDIAN LIFE INSURANCE COMPANY AUTHORIZED REPRESENTATIVE / AGENCY / AGENT QUESTIONNAIRE: Agents and Agencies are not permitted to solicit, sell or procure an application for insurance until they
HEALTH INSURANCE PLAN OF GREATER NEW YORK SELLING AGENT AGREEMENT
HEALTH INSURANCE PLAN OF GREATER NEW YORK SELLING AGENT AGREEMENT THIS AGREEMENT is made and entered into as of the 1 st day of, by and between HEALTH INSURANCE PLAN OF GREATER NEW YORK (hereinafter referred
INSURANCE REQUIREMENTS FOR VENDORS
INSURANCE REQUIREMENTS FOR VENDORS The Contractor/Vendor shall purchase and maintain for the duration of the contract/work insurance against claims for injuries to persons or damages to property which
Memorial Hermann Health Insurance Company Agency Agreement
Memorial Hermann Health Insurance Company Agency Agreement This Agreement is made and effective the day of 20, by and between Memorial Hermann Health Insurance Company ( Company ), 929 Gessner, Suite 1500,
AGENT OR AGENCY AGREEMENT
AGENT OR AGENCY AGREEMENT This Agreement ("Agreement") dated, 20, ( Effective date ) between ("Agent" or Agency ) and Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California
BROKER AGREEMENT. NOW THEREFORE, in consideration of promises, covenants and agreements hereinafter contain, the parties agree as follows:
THIS AGREEMENT is entered into in the State of California this day of 2006, between Crestline Funding Corporation, hereinafter referred to as Crestline Funding, and, hereinafter referred to as Broker.
Broker agreement (Group Insurance & Group Annuities)
This agreement entered into Between: ( the Company ) and ( the Broker ) witnesseth that in consideration of the mutual covenants of the parties herein contained, the parties hereto agree as follows: 1.
Independent Agent Contract
CONT Independent Agent Contract For use with Independent Agents of: Union Central Life Insurance Company Ameritas Life Insurance Corp. Acacia Life Insurance Company First Ameritas Life Insurance Corp.
PRODUCER 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
AGENCY AGREEMENT ( Agreement )
AGENCY AGREEMENT ( Agreement ) PARTIES: CTC Transportation Insurance Services, LLC (CTC) and ("Agent ). Whereas, CTC is a California domiciled Managing General Agent and places coverage for commercial
Please fax or Email the following to our Licensing Compliance Unit within the next five business days:
Health Net of the Northeast, Inc. P.O. Box 904 www.healthnet.com Dear Broker Partner, At Health Net, we understand the more successful you are, the more successful we become. We are committed to working
Everest/WFGIA New Agent Contracting Set Up Sheet
Everest/WFGIA New Agent Contracting Set Up Sheet WFG Code # Agent s Name: Address: Apt./Suite No.: Phone Number: E-Mail Address: Checklist: Completed Producer History Sheet (9511) Contract (3357) signed
AGENT / AGENCY AGREEMENT
AGENT / AGENCY AGREEMENT This Agreement entered into this day of, 20, by and between Guardian Legal Services, Inc. (GUARDIAN), and General Agent, hereinafter called GA. GUARDIAN has organized a Legal Insurance
THE OHIO STATE TROOPERS ASSOCIATION CRIMINAL DEFENSE LEGAL EXPENSE REIMBURSEMENT INSURANCE POLICY
THE OHIO STATE TROOPERS ASSOCIATION CRIMINAL DEFENSE LEGAL EXPENSE REIMBURSEMENT INSURANCE POLICY I. BENEFITS 1) In consideration of the premium specified on the Declaration Page forming part of this Master
1. RECITALS 2. DEFINITIONS Addendum Business Commission(s) Coverage Employer Participation Agreement Laws Member Officer Premiums Producing Agent
Agency Agreement This Agreement is made by and between BlueCross BlueShield of Tennessee*, Inc., a Tennessee notfor-profit corporation, (hereinafter referred to as BCBST ), and the Agency listed on the
Expanded 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
INDEPENDENT BROKER AGREEMENT October 1, 2011 edition
INDEPENDENT BROKER AGREEMENT October 1, 2011 edition This INDEPENDENT BROKER AGREEMENT made this day of 20 by and between Morstan General Agency of New Jersey, Inc. its affiliates and/or subsidiaries,
To activate this service, read agreement and sign the Signature Page, and return it to CBIA.
INSTRUCTIONS: To activate this service, read agreement and sign the Signature Page, and return it to CBIA. CBIA COBRA / State Continuation Services 350 Church Street Hartford, CT 06103-1126 In addition,
BROKERAGE Development General Agent AGREEMENT
BROKERAGE Development General Agent AGREEMENT BANNER LIFE INSURANCE COMPANY ROCKVILLE, MARYLAND Agreement of Brokerage Development General Agent 1. APPOINTMENT Subject to the terms and conditions of this
CHECKLIST. SIS Insurance Services 3250 Grey Hawk Ct. Carlsbad, CA 92010
Dear Producer: SafeBuilt Insurance Services, Inc. (SIS), DBA: Structural Insurance Services (SIS) looks forward to doing business with your agency and beginning a good working relationship. CHECKLIST Legible
Underwriting Solutions of America BROKER SALES & MARKETING AGREEMENT
Underwriting Solutions of America BROKER SALES & MARKETING AGREEMENT THIS SALES & MARKETING AGREEMENT (herein Agreement ) is entered into and effective as of the day of, 2012, by and between Underwriting
AGENCY MARKETING AGREEMENT
AGENCY MARKETING AGREEMENT AGENCY MARKETING AGREEMENT ("Agreement") between NSM INSURANCE GROUP, LLC, a Pennsylvania corporation, CARE PROVIDERS INSURANCE SERVICES, LLC, a Texas corporation, and Condon
PAY-ME-NOW PAYMENT GATEWAY AND VIRTUAL TERMINAL SOFTWARE RESELLER AGREEMENT. PayMeNow.com Toll Free (800) 223-4097
PAY-ME-NOW PAYMENT GATEWAY AND VIRTUAL TERMINAL SOFTWARE PAGE 1 OF 7 This Reseller Agreement ( Agreement ) is made effective as of the date set forth below by and between Applied Merchant Systems, Inc.
MORTGAGE BROKER AGREEMENT
MORTGAGE BROKER AGREEMENT This Mortgage Broker Agreement (the "Agreement") is entered into by and between: ST. CLOUD MORTGAGE, a California Corporation (the "Lender"), and (the "Mortgage Broker") as of
BUSINESS CREDIT APPLICATION
BUSINESS CREDIT APPLICATION 1. Legal Name of Applicant: 2. Trade Name (d/b/a) if Applicable: E.I.N.: 3. Type of Bus. Years in Business: 4. Website: www. General 5. Has Applicant Changed its Name or Advertised
SECTION 00900 PERFORMANCE BOND., hereinafter called PRINCIPAL, and
SECTION 00900 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: THAT (Name or Contractor) a (Address of Contractor) (Corporation, Partnership, or Individual), hereinafter called PRINCIPAL, and (Name
SALES REPRESENTATIVE AGREEMENT
SALES REPRESENTATIVE AGREEMENT THIS AGREEMENT is made on this day of, 200, by and between Blinc Inc., a Delaware corporation, with its primary mailing address at 1141 South Rogers Circle, Suite 9, Boca
INDIAN HARBOR INSURANCE COMPANY (herein called the Company)
INDIAN HARBOR INSURANCE COMPANY (herein called the Company) This is a claims made Policy with defense expenses included. Please read and review the Policy carefully. INSURANCE AGENTS AND BROKERS ERRORS
ATTENTION CARRIER! PLEASE FAX THIS COMPLETED FORM ALONG WITH THE FOLLOWING DOCUMENTS TO 315-622-5281
ATTENTION CARRIER! Carrier Name: PLEASE FAX THIS COMPLETED FORM ALONG WITH THE FOLLOWING DOCUMENTS TO 315-622-5281 Signed Breakaway Transport Broker/Carrier Agreement Workman s Compensation letter Copy
Agency Agreement. The Superpreferred Company. The Preferred Company. The Standard Company NAME OF AGENT ADDRESS OF AGENT. I.
Agency Agreement The Superpreferred Company The Preferred Company The Standard Company Each of the companies designated above by the mark X opposite its names is a party to this Agreement and is hereafter
388 Blohm Ave. PO Box 388 Aromas CA 95004-0388 (831)726-3155 FAX (831)726-3951 email aromaswd@aol.com ADDENDUM NO. 1
388 Blohm Ave. PO Box 388 Aromas CA 95004-0388 (831)726-3155 FAX (831)726-3951 email aromaswd@aol.com May 6, 2015 To: All Plan Holders From: Vicki Morris General Manager Subject: Water Serviceline Installation
AGREEMENT FOR FINANCIAL AND ACCOUNTING CONSULTATION SERVICES
AGREEMENT FOR FINANCIAL AND ACCOUNTING CONSULTATION SERVICES THIS AGREEMENT is made as of December 1, 2003, by and between the San Francisquito Creek Joint Powers Authority, a body corporate and politic
City of Boulder, Colorado. Request for Proposals RFQ #74-2012. Pest Control
City of Boulder, Colorado Request for Proposals RFQ #74-2012 The City of Boulder is soliciting Statements of Qualification and hourly billing rates from contractors with experience in General Scope of
AIA Document A310 TM 2010
AIA Document A310 TM 2010 Bid Bond CONTRACTOR: OWNER: «Lane County» «125 East Eighth Avenue BOND AMOUNT: $ PROJECT: (Name, location or address, and Project number, if any) «Lane County Adult Corrections
NATIONAL CONTRACTORS INSURANCE COMPANY, INC., A RISK RETENTION GROUP SUBSCRIPTION AND SHAREHOLDERS AGREEMENT
1 NATIONAL CONTRACTORS INSURANCE COMPANY, INC., A RISK RETENTION GROUP NOTICE SUBSCRIPTION AND SHAREHOLDERS AGREEMENT This policy is issued by your risk retention group. Your risk retention group may not
SANTA BARBARA METROPOLITAN TRANSIT DISTRICT. Invitation for Bids for Architectural & Engineering Services. Addendum Number 1 Issued August 5, 2013
SANTA BARBARA METROPOLITAN TRANSIT DISTRICT Invitation for Bids for Architectural & Engineering Services Addendum Number 1 Issued August 5, 2013 The Santa Barbara Metropolitan Transit District (MTD) herewith
INSURANCE AGENT AGREEMENT
INSURANCE AGENT AGREEMENT THIS INSURANCE AGENT AGREEMENT is made, 200_ by and between Athens Area Health Plan Select, Inc. ( AAHPS or the Plan ), and ( Agent ). RECITALS: WHEREAS, AAHPS is licensed to
One Card Office Division of Student Affairs
One Card Office Division of Student Affairs THIS AGREEMENT, made and entered into this day of, 20 ( Effective Date ) is between The University of Connecticut, on behalf of its One Card Office and, having
Ceres Unified School District INDEPENDENT CONTRACTOR AGREEMENT 2013-2014
Ceres Unified School District INDEPENDENT CONTRACTOR AGREEMENT 2013-2014 THIS CONTRACT is hereby entered into by the Ceres Unified School District, hereinafter referred to as DISTRICT, and CONTRACTOR MAILING
Independent Contractor Agreement. Name of Contractor: Address: Social Security or Tax I.D. Number:
HOFSTRA UNIVERSITY Name of Contractor: Address: Social Security or Tax I.D. Number: Independent Contractor Agreement THIS INDEPENDENT CONTRACTOR AGREEMENT (together with any attachments referred to below,
GSG APPRAISAL MANAGEMENT, LLC INDEPENDENT FEE APPRAISER APPLICATION
GSG APPRAISAL MANAGEMENT, LLC INDEPENDENT FEE APPRAISER APPLICATION Thank you for your interested in joining the GSG Appraisal Management (GSG AMC) residential appraisal panel. In order to be considered
SECURITIES LENDING AUTHORIZATION
SECURITIES LENDING AUTHORIZATION This AGREEMENT ( Agreement ) made as of the day of, 2009, by and between the WEST VIRGINIA BOARD OF TREASURY INVESTMENTS, a public body corporate of the State of West Virginia
LLOYD'S OF LONDON ARCHITECTS/ENGINEERS PROFESSIONAL LIABILITY CLAIMS MADE AND REPORTED INSURANCE POLICY NOTICE
LLOYD'S OF LONDON ARCHITECTS/ENGINEERS PROFESSIONAL LIABILITY CLAIMS MADE AND REPORTED INSURANCE POLICY NOTICE This is a claims made and reported Policy. Unless stated otherwise coverage afforded under
CONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC
CONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC INSTRUCTIONS TO INVESTORS EACH PROSPECTIVE INVESTOR IN INCROWD ALABAMA FUND I, LLC (THE COMPANY ) SHOULD EXAMINE THE SUITABILITY OF THIS TYPE OF INVESTMENT
AGREEMENT FOR CONSULTING SERVICES (Sponsored Research) Consulting Agreement Number CA###-####-#### IIT PURCHASE ORDER NO. **
AGREEMENT FOR CONSULTING SERVICES () Consulting Agreement Number CA###-####-#### IIT PURCHASE ORDER NO. ** THIS AGREEMENT is made and entered into as of this day of, 20 (the Effective Date ) by and between
PROJECT NO. 2733, RFP NO. 14-15/02. Peralta Community College District. 333 East 8th Street, Oakland, CA 94606. Questions
PROJECT NO. 2733, RFP NO. 14-15/02 Peralta Community College District 333 East 8th Street, Oakland, CA 94606 August 7, 2014 ADDENDUM No. 1 This addendum supersedes items of the original contract documents
SAMPLE SERVICES CONTRACT
SAMPLE SERVICES CONTRACT The parties to this contract are the SAN DIEGO COUNTY WATER AUTHORITY, a county water authority, (the Water Authority) and, [a / an], having its principal place of business at
STANDARD AGENT QUESTIONNAIRE
STANDARD AGENT QUESTIONNAIRE Producer Information Name of firm: Principal address: Mailing address (if different from above): Telephone: Facsimile: Email: Corporation ( ) Partnership ( ) Individual ( )
Please submit your contracting paperwork to: Emrick Insurance Marketing Group. licensing@emrickgroup.com. Fax: 217-833-2046 or
Please submit your contracting paperwork to: Emrick Insurance Marketing Group Email: licensing@emrickgroup.com Fax: 217-833-2046 or Mail: Emrick Insurance Marketing Group PO Box 506 Griggsville, IL 62340
Lenders Axis LLC Working Capital Sales Agent Agreement Lenders Axis Sales Agent Agreement V 2.0
Lenders Axis LLC Working Capital Sales Agent Agreement Lenders Axis Sales Agent Agreement V 2.0 This Sales Agent Agreement (the Agreement ) is made and effective as of this the day of 13 by and between
How To Manage A Power Station
CARESERV TECHNOLOGIES, LLC SERVICE AGREEMENT COLOCATION SERVICES SCHEDULE Version 2014.1 (01.01.2014) This Schedule, together with any Order referencing this Schedule or pursuant to which the services
NATIONAL MARKET SYSTEM PLAN OF THE OPTIONS REGULATORY SURVEILLANCE AUTHORITY
NATIONAL MARKET SYSTEM PLAN OF THE OPTIONS REGULATORY SURVEILLANCE AUTHORITY The self-regulatory organizations named below as the parties to this plan, and any other self-regulatory organizations that
175 TownPark Drive, Suite 400, Kennesaw, GA 30144 APPROVED UNDERWRITER AGREEMENT
175 TownPark Drive, Suite 400, Kennesaw, GA 30144 APPROVED UNDERWRITER AGREEMENT THIS APPROVED UNDERWRITER AGREEMENT (the Agreement ) is made and entered into as of this day of, 20, by and between, (the
Kentucky Department of Education Version of Document A312 2010
Kentucky Department of Education Version of Document A312 2010 Performance Bond CONTRACTOR: (Name, legal status and address) SURETY: (Name, legal status and principal place of business) OWNER: (Name, legal
BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT
BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT This BUSINESS ASSOCIATE AGREEMENT ( Agreement ) dated as of the signature below, (the Effective Date ), is entered into by and between the signing organization
SUB-PRODUCER AGREEMENT (Alfa Insurance Agent)
www.neagencies.com 6467 Main Street, Suite 104 Williamsville, NY 14221 phone: (800) 333-0980 fax: (716) 954-0219 SUB-PRODUCER AGREEMENT (Alfa Insurance Agent) Northeast Agencies, Inc. ( NEA ), a New York
BROKER/SHIPPER AGREEMENT
BROKER/SHIPPER AGREEMENT THIS BROKERAGE AGREEMENT ( Agreement ) is made and entered on, 20, by and between ( SHIPPER ) and Transportation Solutions Group, LLC DBA Redwood Multimodal ( BROKER ) (collectively,
STREET ADDRESS: 3250 GREY HAWK CT., CARLSBAD, CA 92010 PHONE: 760-599-7242 *FAX:
Dear Producer: SafeBuilt Insurance Services, Inc. (SIS), DBA: Structural Insurance Services (SIS) looks forward to doing business with your agency and beginning a good working relationship. CHECKLIST Legible
Excess Lawyers Professional Liability Policy DECLARATIONS. Attaching to and forming part of
Excess Lawyers Professional Liability Policy DECLARATIONS Attaching to and forming part of THIS IS A CLAIMS MADE EXCESS PROFESSIONAL LIABILITY INSURANCE - PLEASE READ CAREFULLY AND DISCUSS WITH YOUR INSURANCE
Banner Life Insurance Co.
Banner Life Insurance Co. New Agent Name: States to be appointed in: (Attach license copies) Anti-Money Laundering Training Requirements: AML training was completed through LIMRA on / / AML training was
Collection Escrow Instructions
Collection Account No. Payee/Seller Name: Address: Telephone No. Email: To: Attn: Collection Escrow Instructions Escrow No. Obligor/Buyer Name: Address: Telephone No. Email: Pacific Trust Deed Servicing
GRANTS PASS SCHOOL DISTRICT INDEPENDENT CONTRACTOR AGREEMENT DATE: 9 /8 /2015
GRANTS PASS SCHOOL DISTRICT INDEPENDENT CONTRACTOR AGREEMENT DATE: 9 /8 /2015 SECTION 1. IDENTITY OF INDEPENDENT CONTRACTOR This Agreement is between Grants Pass School District Number 7 (hereinafter District
GROUP HEALTH INCORPORATED SELLING AGENT AGREEMENT
GROUP HEALTH INCORPORATED SELLING AGENT AGREEMENT This Agreement, made between Group Health Inc., having its principal office at 441 Ninth Avenue, New York, NY 10001 ("GHI"), and, having its principal
Broker Agreement. Between: (referred to as Empire Life ) AND. (referred to as Broker ) Street Address: City or Town: Province: Postal Code:
Broker Agreement Between: THE EMPIRE LIFE INSURANCE COMPANY (referred to as Empire Life ) AND (referred to as Broker ) Street Address: City or Town: Province: Postal Code: Effective Date: Broker and Empire
REQUEST FOR PROPOSAL OFFICE OF THE NEVADA ATTORNEY GENERAL GRANTEE- FORECLOSURE RELIEF PROGRAM MAY 20, 2011
REQUEST FOR PROPOSAL OFFICE OF THE NEVADA ATTORNEY GENERAL GRANTEE- FORECLOSURE RELIEF PROGRAM MAY 20, 2011 SCOPE OF WORK: The Office of the Attorney General (AGO) recently received a settlement from Wells
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND: SMALL BUSINESS HEALTH OPTIONS PROGRAM PRODUCER AGREEMENT
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND: SMALL BUSINESS HEALTH OPTIONS PROGRAM PRODUCER AGREEMENT This PRODUCER AGREEMENT ( Agreement ) made effective as of the day of, 20 (the Effective Date ) is between
THE UNIVERSITY OF UTAH INDEPENDENT CONTRACTOR SERVICES AGREEMENT INSTRUCTIONS
THE UNIVERSITY OF UTAH INDEPENDENT CONTRACTOR SERVICES AGREEMENT INSTRUCTIONS Contracting for Independent Contractor services with the University of Utah may require completion of the following: Employee/Independent
Berkeley Unified School District ROUTING FORM Contract, MOU and Amendment Approval
ROUTING FORM Contract, MOU and Amendment Approval All Independent Contractor Agreement, MOU and Amendment Forms should be routed to Purchasing Department first for tracking. Purchasing will send the documents
BROKER/CO-BROKER INTERMODAL TRANSPORTATION AGREEMENT
BROKER/CO-BROKER INTERMODAL TRANSPORTATION AGREEMENT THIS BROKER/CO-BROKER INTERMODAL TRANSPORTATION AGREEMENT ( Agreement ) is made and intended to be effective this day of, 20 by and between, having
AGREEMENT BETWEEN THE CITY OF BEVERLY HILLS AND VENDOR TBD FOR PURCHASE AND INSTALLATION OF AUTOMATED LICENSE PLATE RECOGNITION SYSTEMS
AGREEMENT BETWEEN THE CITY OF BEVERLY HILLS AND VENDOR TBD FOR PURCHASE AND INSTALLATION OF AUTOMATED LICENSE PLATE RECOGNITION SYSTEMS NAME OF CONTRACTOR: RESPONSIBLE PRINCIPAL OF CONTRACTOR:, Vendor
Master Software Purchase Agreement
Master Software Purchase Agreement This Master Software Purchase Agreement ( Agreement ) is entered into as of Wednesday, March 12, 2014 (the Effective Date ) by and between with principal offices at (
LIMITED LIABILITY COMPANY OPERATING AGREEMENT, LLC
LIMITED LIABILITY COMPANY OPERATING AGREEMENT, LLC A MemberManaged Limited Liability Company OPERATING AGREEMENT THIS OPERATING AGREEMENT is made and entered into effective, 20, by and among: [list the