| PRODUCERS AGREEMENT |
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This agreement made and entered into this |
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by and between |
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(Hereinafter referred as “the Producer) and Hartan Brokerage
Inc. and/or Hartan Brokerage Inc. D/B/A Hartan Specialty Programs, 33
West 60th Street, New York, NY 10023 (Hereinafter referred to as the
Company).
- The Producer warrants and represents that they are duly authorized
tobusiness under the laws of the states in which it is ]o catdd of
soliciting insurance business am desire or to continue to obtain insurance
coverages for its clients in compliance with all of the applicable
laws and regulations of said state.
- The Company shall pay the Producer as commission. a percentage rate
of the premium on each policy written and paid for under this Agreement
at the rate of commission to be agreed For each such policy written,
The Producer shall pay the Company return commissions at the same
rate on any return premiums, including return premiums on cancellations
ordered or made by the Company said percentage rate of policy premiums
shall Producer's solo consideration hereunder; Company shall not be
responsible for any expenses incurred by Producer, of any kind whatsoever.
- Premiums net of commission received by the Producer for coverage
placed through the Company are the property of the insurance company
underwriting the coverage and shall he held by the Producer in a fiduciary
capacity as trustee for the Company until delivered to the Company
for remittance to the insurer and may not be used by the Producer
for any other purpose. The privilege of retaining commissions from
the premiums received by the Producer shall not construed as changing
the relationship of the respective parties hereto.
- The Producer shall accept the Company's individual invoice for each
policy binder issued at the time of binding which shall be settled
on or before the due date listed on the bottom of said invoice. The
Producer hereby guarantees all premiums due to the Company on all
coverages placed by it with the Company whether or not they are collected
by the Producer. Any credit extended to the insured or others shall
be at the sole risk of the Producer. If Producer does not pay Company,
within the time specified, premium due on any invoice, the Company
is hereby authorized to cancel any policy(ies) for which the Company
has not been paid and to require Producer to pay any earned premium
thereon.
- The Company shall have access at all reasonable time to the Producer's
books and records for the purpose of determining any fact relating
to money due the Company on all transactions pertaining to coverages
entered into under this agreement.
- Nothing herein contained shall be construed as permitting the Producer
to bind any risk, which has nut been authorized by the Company, or
to permit the Producer to hold himself if out as an agent of any Company.
- This agreement is solely between the Producer and the Company. The
Company assumes no responsibility toward any policyholder or sub-producer
with regard to the adequacy, amount or form of any coverage obtained
through the Company. The Producer agrees to hold the Company harmless
from any claim asserted against the Company in following the instructions
of the Producer.
- The Company shall have the absolute right to decline any business
offered to it by the Producer.
- This Agreement shall apply to all coverages in effect on the date
on the execution of this Agreement or to coverages, which may thereafter
be placed by the Producer through the Company, This Agreement may
be terminated at any time by either party giving written notice to
the other. Alter the date of termination of this Agreement, unless
otherwise stipulated at the option of the Company, the Producer shall
complete the collection and account to the Company for all premiums,
commissions, and other transactions unaccounted for on the date of
termination or arising thereafter in respect of outstanding insurance.
This Agreement shall automatically be assigned on the effective date
of the sale or transfer of the Producer's business, or its consolidation
with a successor firm.
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This Agreement has been executed this |
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| Hartan Brokerage, Inc. By Susan Percoeo, Executive
Vice President |
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Producer |
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By |
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Title |
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| BROKER PORFILE |
| A. GENERAL INFORMATION |
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Name of Firm |
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Main Address |
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Other Location (Town, State) |
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Tel. / Fax No. |
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Web Site |
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Years in Business |
years |
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Total No. of Employees |
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Partners or Corporate Officers |
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| B. VOLUME & MIX OF BUSINESS |
| 1. |
Total Premium Volume |
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Commercial Lines |
$
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Personal Lines |
$
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Life, Health, Benefits |
$
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Surety Bonds |
$
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Other |
$
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Total |
$
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| 2. |
Do you accept business from other Retail Agents? |
Yes
No |
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If yes, what % of total volume is from retailers? |
% |
| 3. |
Commercial Lines Industry Mix |
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Contracting |
% |
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Entertainment |
% |
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Financial Institutions |
% |
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Manufacturing |
% |
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Municipalities |
% |
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Real Estate |
% |
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Retailing |
% |
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Service |
% |
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Wholesaling |
% |
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Other |
% |
| Please describe any other classes or speciality
areas: |
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| C. AGENCY MARKETING |
| 1. |
Please describe the organization's marketing structure (including
names of key contacts) |
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| 2 |
Please list all producers (max 10) include their
area of speciality & years in business |
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| D. MARKET PLACEMENT |
| 1. |
Please list your top 5 markets, including approximate
Commercial volume : |
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| 2 |
Please list all other direct Commercial markets |
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| 3. |
Please list your top 3 Wholesale Brokerage markets
and associated volume |
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| OTHER INFORMATION / DOCUMENTATION |
| 1. |
Do you maintain Errors and Omissions Coverage over all officers
and employees?
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Yes
No |
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If "yes", please attach a certificate of insurance
issued by the carrier reflecting full details.
If "no", please explain. |
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| 2. |
Do you maintain Fidelity Coverage over all officers and employees?
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Yes
No |
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If "yes", please attach a certificate of insurance
issued by the carrier reflecting full details.
If "no", please explain. |
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| 3. |
License Numbers and States (Please attach copies) |
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| 4. |
Please submit a copy of the latest annual report
or financial statement with this survey. |
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This form is completed by |
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Name |
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Title |
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Date |
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| I have read and agree with the terms above. |
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I agree. |
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Your e-mail address |
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Your comments |
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