PRODUCERS AGREEMENT

  This agreement made and entered into this
  by and between

(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).

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. The Company shall have the absolute right to decline any business offered to it by the Producer.
  9. 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.
 
  This Agreement has been executed this
Hartan Brokerage, Inc. By Susan Percoeo, Executive Vice President
  Producer
  By
  Title
     
BROKER PORFILE
A. GENERAL INFORMATION
  Name of Firm
  Main Address
  Other Location (Town, State)
  Tel. / Fax No.
  Web Site
  Years in Business years
  Total No. of Employees
  Partners or Corporate Officers
 
Title Name
B. VOLUME & MIX OF BUSINESS
1. Total Premium Volume  
  Commercial Lines $
  Personal Lines $
  Life, Health, Benefits $
  Surety Bonds $
  Other $
  Total $
2. Do you accept business from other Retail Agents? Yes
No
  If yes, what % of total volume is from retailers? %
3. Commercial Lines Industry Mix  
  Contracting %
  Entertainment %
  Financial Institutions %
  Manufacturing %
  Municipalities %
  Real Estate %
  Retailing %
  Service %
  Wholesaling %
  Other %
Please describe any other classes or speciality areas:
C. AGENCY MARKETING
1. Please describe the organization's marketing structure (including names of key contacts)
2 Please list all producers (max 10) include their area of speciality & years in business
 
Name Area of Speciality Years in business
D. MARKET PLACEMENT
1. Please list your top 5 markets, including approximate Commercial volume :
 
Markets Approximate Commercial Volume
$
$
$
$
$
2 Please list all other direct Commercial markets
3. Please list your top 3 Wholesale Brokerage markets and associated volume
 
Wholesale Brokerage Associated Volume
$
$
$
OTHER INFORMATION / DOCUMENTATION
1. Do you maintain Errors and Omissions Coverage over all officers and employees?
Yes
No
  If "yes", please attach a certificate of insurance issued by the carrier reflecting full details.
If "no", please explain.
2. Do you maintain Fidelity Coverage over all officers and employees?
Yes
No
  If "yes", please attach a certificate of insurance issued by the carrier reflecting full details.
If "no", please explain.
3. License Numbers and States (Please attach copies)
 
License Numbers States
4. Please submit a copy of the latest annual report or financial statement with this survey.
   
  This form is completed by
  Name
  Title
  Date
 
I have read and agree with the terms above.
I agree.
  Your e-mail address
  Your comments