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 502-394-3012.
Sincerely,
Mary Carney
CCMSI/KRFSIF Account Manager
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:
Phone Number:
Ext:
Zip Code:
Fax Number:
Email:
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
AGENCY ERRORS & OMISSIONS INSURANCE
IMPORTANT: Please provide E & O Certificate copy when submitting
this questionnaire:
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
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.
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.
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:
, 2012 .
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.
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.
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:
, 2012 .
SCHEDULE A
Client Name
Effective Date
of Client
Contribution