"AGENCY": LESTER KALMANSON AGENCY , INC. &/OR MITCHEL KALMANSON
235 S. MAITLAND AVE. SUITE 201
PO BOX 940008
MAITLAND, FL 32794-0008 U.S.A.
PHONE: 407-645-5000 / FAX: 407-645-2810
WWW.LKALMANSON.COM
INFORMATION
NOTE (S): In order to bind and bill any account, we must have this form completed along with:
A. A copy of the Producer Agreement
B. Your updated E & O declaration page with applicable policy limits.
C. A copy of your W-9
D. A copy of the license of the agent (s) listed above for our records for the applicable State
E. The Producer Agreement Signature form
(hereinafter referred to as “Producer”)
follows:
1.This agreement shall apply to all current insurance contract (s) / policies already placed and in force at the date hereof and for all future insurance contract(s) and/or policies which may be placed by “Agency” on behalf and at the request of the “Producer”
2. No insurance contract (s) may be returned to “Agency” by “Producer” and/or their respective insureds, for flat cancellation unless it is returned and received by carrier / underwriter, C/O “Agency”, prior to the effective date of the contract. Earned premium shall be computed and charged on every contract and/or policy canceled after the effective date in accordance with the stated short rate or minimum premium stated of such insurance contract and/or applicable policy cancellation provisions of such contract.
3. Any stamping fees and/or policy fees and/or inspection fees and/or state surplus lines taxes applicable to any contract and/or policy of insurance placed with any carrier/underwriter, which are not recoverable, are fully earned from the inception date of the insurance, and in case a portion of the premium shall be returned by reason of cancellation either on behalf of the insured or the company or by reason of reduction of premium, no amount shall be returnable in respect of such taxes assessments and/or fees, until and unless such taxes, fees, and/or assessments have been, in fact, recovered by “Agency” and the amount to be returned shall in no event exceed the amount so recovered, so long as insured and/or “Producer” do not owe “Agency” any monies.
4. The full amount of premium, fees, assessments, and applicable state taxes, less commission is due to “Agency” at time of binding, unless otherwise agreed in writing by “Agency”. “Producer” is aware and responsible that most annual policies will be Thirty Five Percent (35%) minimum earned of the annual premium, and all short term policies are fully earned (100%), plus applicable fees and taxes upon binding unless otherwise stated.
5. In the event that an additional premium shall be due under any insurance contract/policy as a result of a policy audit, additional exposure, which results in an increase in premium due for an insurance contract/policy, the “Producer” will make all reasonable efforts to collect amounts due timely. “Producer” will be relieved of responsibility for additional premium due, so adjusted or determined, if “Producer” notifies “Agency” in writing within fourteen (14) days after the invoice date, stating that “Producer” has made diligent efforts and forwards copies of such, and is unable to collect such premiums and, provided the insurer releases “Agency” of liability for such premium. Failure to give “Agency” timely notice shall constitute “Producer's” acceptance of responsibility to pay such premiums. If commission applies to these adjustments, none will be allowed to “Producer” on premium collected directly by “Agency” or insurer under this provision. Insured will still be responsible for additional premium due to carrier/underwriters.
6. “Agency” will use its best efforts to give the “Producer” reasonable advanced notice of the expiration of all policies, but failure of “Agency” to provide such notice will not render “Agency” liable.
7. The furnishing of promotional materials, including, but not limited to applications, rate schedules, brochures, and/or any other material by “Agency” to the “Producer” does not create and/or imply any “Agency” relationship and/or binding authority between “Agency” and the “Producer” unless otherwise agreed to in writing by both parties.
8. No “Producer” has any authority to assign and/or adjust any losses on behalf of “Agency” and/or its company (s) / underwriter (s). All claims are to be immediately reported directly to “Agency” in writing, for assignment, processing and handling.
9. “Producer” acknowledges it is not the agent of, and has no authority to bind any insurance coverage (s) “Agency” or any of its principals or insurer (s). “Producer” warrants it is the agent of the insured and acknowledges “Agency” bears no “Agency” or fiduciary responsibility to the insured
10. “Producer” agrees that they are responsible for filing any necessary and/or applicable state surplus lines taxes and/or filings required by the state on any contracts or insurance policies written by “Agency” unless otherwise agreed.
11. A) During the entire term of the “Producer” Agreement, Producer will indemnify and hold harmless the “Agency” against any and all claims, debts, demands, or obligations which may be made against “Agency” or against its interest, arising out of, and/or in connection with any alleged act, and/or negligence of the “Producer” and/or omission of the “Producer” or any person claiming under, by, or through “Producer” except to the extent of “Agency’s” negligence.
B) During the term of the Producer’s Agreement, “Agency” agrees to indemnify and hold harmless the “Producer” against any and all claims, debts, demands, or obligations which may be made against “Producer” or against its interest, arising out of and/or in connection with any alleged act and/or negligence of the “Agency”, except to the extent of “Producer’s” negligence.
12. “Producer” shall have “Agency” added as additional insured (s) to their liability insurance policy (E&O) at their own expense.
13. “Producer’s” general liability insurance will be primary and non-contributory to any liability policies held by “Agency”
14.“Producer” will have its liability carrier issue a Waiver of Subrogation in favor of “Agency” at their own expense.
15. GOVERNING LAW. All of the rights and remedies of the parties shall be governed by the provisions of this instrument and by the laws of the State of Florida and venue shall lie in Orange County, Florida, USA.
16. LEGAL ACTION. Any legal action brought as a result of any controversy of a claim arising out of or relating to this agreement shall be governed by the laws of the State of Florida and venue shall be in Orange County, Florida USA.
17. RIDER(S) AND/OR ADDENDUM(S): If any rider (s) and/or addendum (s) are attached hereto this agreement, then the provisions thereof shall have the same force and effect as if set forth herein, so long as they are in writing and signed and agreed by all parties – “Producer” and “Agency”.
18.WRITTEN MODIFICATIONS. No modification, release, discharge, or waiver of any provision hereof shall be of any force, effect, or value unless signed in writing by the party to be charged therewith, or its duly authorized agent or attorney.
19.ENTIRE AGREEMENT. This instrument contains the entire agreement between parties as of the date with respect to the subject matter hereof. The execution hereof has not been induced by either party by representations, promises, or understandings not expressed herein. There are no collateral agreements, stipulations, promises, or undertakings whatsoever upon the respective parties in any way touching the subject matter of this instrument which are not expressly contained in it.
20.This agreement may be canceled at any time by written notice of either party to the other, but said cancellation shall not alter in any way the continued application of this agreement to insurance contracts/policies effected prior to the date of such cancellation.
21. Any amendment to this agreement shall be made only with the written consent of both parties and attached hereon through addendum.
22.This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument.
the dates indicated on the "Producer Agreement Signature" form.
PLEASE INITIAL AND DATE TO ACCEPT THE TERMS OF THE APPLICATION ( REQUIRED TO PROCESS APPLICATION )
AFTER SUBMITTING THE ONLINE APPLICATION
DOWNLOAD, PRINT, AND COMPLETE THE "PRODUCER AGREEMENT SIGNATURE" FORM
THIS FORM REQUIRES WET SIGNATURES AND MUST BE MAILED TO OUR OFFICE TO
PROCESS THE APPLICATION
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