Fill and Sign the Broker Agreement Form

- 1 – INDEPENDENT CONTRACTOR BROKER AGREEMENT THIS AGREEMENT made and entered into on the date last written below, by and betwee n __________________ (hereinafter "Employer"), and __________________, an independent contractor (hereinafter "Broker"); WHEREAS, the Employer desires to retain the services of Broker, and Broker desires to rende r services to the Employer, upon the terms and conditions hereinafter stated: NOW, THEREFORE, the parties hereto, intending to be legally bound hereby, do hereby promise and agree as follows: SECTION 1 – SCOPE OF DUTIES TO BE PROVIDED 1.1 Term . Employer agrees to hire Broker, at will, for a term commencing on __________________ , 20 and continuing until terminated in accordance with Section 4 of this agreement. 1.2 Duties . Broker agrees to perform work for the Employer on the terms and conditions set forth in this agreement and agrees to devote all necessary time and attention (reasonable periods of illness excepted) to the performance of the duties specified in this agreement. Broker's duti es shall include the following: _________________ _. Broker further agrees that in all aspects of such work, Broker shall comply with the poli cies, standards, regulations of the Employer from time to time established, and shall perform the duties assigned faithfully, intelligently, to the best of his/her ability, and in the best int erest of the Employer. SECTION 2 – CONFIDENTIALITY 2.1 Confidentiality . Broker acknowledges and agrees that all records, lists and information pertaining to clients and cases and other Employer and client data and i nformation related to its business (hereinafter collectively "Confidential Information") are valuable assets of the Employer. Except for disclosures required to be made to advance the business of the Employer and information which is a matter of public record, Broker shall not, during the term of this Agreement or after the termination of this Agreement, disclose any Confidential Informa tion to any person or use any Confidential Information for the benefit of Broker or any other person, except with the prior written consent of the Employer. Employer understands that certai n Confidential Information may be required to be disclosed to certain individuals: direct ors, officers, employees, agents, or advisors (collectively, Representatives) of Broker. Broker shall maintain records of the persons to whom Confidential Information is distributed, will inform all - 2 – such persons of the confidential nature of the information, will direct them to treat such information in accordance with this agreement, will exercise such precautions or me asures as may be reasonable in the circumstances to prevent improper use of Confidential Information by t hem, and will be responsible for any breaches by them of the provisions of this agreement. The term “confidential information” does not include information that is or becomes publicly a vailable (other than through breach of this Agreement) or information that is or becomes available to Broker on a non-confidential basis, provided that the source of such information was not known by Broker (after such inquiry as would be reasonable in the circumstances) to be bound by a confidentiality agreement or other legal or contractual obligation of confidentialit y with respect to such information. In the event that Broker or any of Broker’s representatives, assigns, or agents are requested or required by law or legal process to disclose any of the Confidential Informa tion, the party required to disclose such information shall provide Employer with prompt oral and written notice before making any disclosure. In addition, Confidential Information may be disclosed to the extent required in the course of inspections or inquiries by federal or state regulatory agencies to whose jurisdiction Broker is subject and that have the legal ri ght to inspect the files that contain the Confidential Information, and Broker will advise Employer prom ptly upon such disclosure. 2.2 Return of Documents . Broker acknowledges and agrees that all originals and copies of records, reports, documents, lists, plans, memoranda, notes and other documentation related to the business of the Employer or containing any Confidential Information shall be the sole and exclusive property of the Employer, and shall be returned to the Employer upon the terminat ion of this Agreement or upon the written request of the Employer. 2.4 No Release . Broker agrees that the termination of this Agreement shall not release Broker from any obligations under Section 2.1 or 2.2. SECTION 3 - COMPENSATION 3.1 Compensation . In consideration of all services to be rendered by Broker to the Employer, the Employer shall pay to said ________________ __ the amount of $ per bi- weekly month year other ________________ __ . 3.2 Withholding; Other Benefits . Compensation paid pursuant to this Agreement shall not be subject to the customary withholding of income taxes and other employment taxes. Broker shall be solely responsible for reporting and paying any such taxes. The Employer shall not provide Broker with any coverage or participation in the Employer's accident and health insuranc e, life insurance, disability income insurance, medical expense reimbursement, wage continuati on plans, or other fringe benefits provided to regular employees. - 3 – SECTION 4 - TERMINATION 4.1 Termination at Will. This Agreement may be terminated by the Employer immediately, at will, and in the sole discretion of Employer. Broker may terminate this Agreement upon days written notice to Employer. This Agreement also may be terminated at any time upon the mutual written agreement of the Employer and Broker. 4.2 Contract Duration Notwithstanding Section 4.1of this Agreement, the duration of this contract shall be for a period of months years and shall terminate on __________________ , 20 . SECTION 5 - INDEPENDENT CONTRACTOR STATUS 5.1Broker acknowledges that he/she is an independent contractor and is not an agent, partner, joint venturer nor employee of Employer. Broker shall have no authority to bind or otherwise obligate Employer in any manner beyond that specified in the Agreement, nor shall Broker represent t o anyone that it has a right to do so. Broker further agrees that in the event that the Employer suffers any loss or damage as a result of a violation of this provision Broker shall indemnify and hold harmless the Employer from any such loss or damage. 5.2 Assignment. The Broker shall not assign any of his/her rights under this agreement, or delegate the performance of any of his/her duties hereunder, without the prior written consent of the Employer. SECTION 6 - REPRESENTATIONS AND WARRANTIES OF BROKER 6.1 Broker represents and warrants to the Employer that there is no employment contract or othe r contractual obligation to which Broker is subject, which prevents Broker from entering i nto this Agreement or from performing fully Broker's duties under this Agreement. 6.2 Broker represents that he/she is licensed by the appropriate licensing agency for the __________________ profession and that he/she is in good standing with such agency. 6.3The following are the required licenses and certifications held by broker: _________________ _ . SECTION 7 - INSURANCE . Broker shall obtain and maintain in force, at its own expense, throughout the performance of his/her/its obligations under this Agreement, insurance coverage against claims, regardless of when asserted, that may arise out of, or result from, Broker's operations in connection with the - 4 – services or duties described above. This insurance shall include the following coverage(s) that is(are) checked below: General Malpractice Liability or General Errors and Omissions coverage for losses incurred as a result of professional malpractice or professional errors and omissions made in the performance of this agreement. Fidelity coverage for losses incurred as a result of dishonesty on the part of Broker's employees, agents or sub-brokers. Other Insurance Requirements : _________________ _ . SECTION 8 - MISCELLANEOUS PROVISIONS 8.1The provisions of this Agreement shall be binding upon and inure to the benefit of the heirs, personal representatives, successors and assigns of the parties. Any provision hereof which imposes upon Broker or Employer an obligation after termination or expiration of this Agreement shall survive termination or expiration hereof and be binding upon Broker or Employer. 8.2 No waiver of any provision of this Agreement shall be deemed, or shall constitute, a waiver of any other provision, whether or not similar, nor shall any waiver constitute a continuing wai ver. No waiver shall be binding unless executed in writing by the party making the waiver. 8.3 This Agreement shall be governed by and shall be construed in accordance with the laws of the State of _________________ _ . 8.4This Agreement constitutes the entire agreement between the parties pertaining t o its subject matter and supersedes all prior contemporaneous agreements, representations and understandings of the parties. No supplement, modification or amendment of this Agreement shall be bi nding unless executed in writing by all parties. 8.5 Severability. If any provision of these policies and regulations or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of these policies and regulations which can be given effect without the i nvalid provision or application, and to this end the provisions of these policies and regulations are severable. In lieu thereof there shall be added a provision as similar in terms to such illegal, invalid and unenforceable provision as may be possible and be legal, valid and enforceable . WITNESS OUR SIGNATURES, this the day of __________ ,20 . - 5 – _________________ _ EMPLOYER _________________ _ BROKER