Business AOR Application

BUSINESS AOR APPLICATION

Recitals

WHEREAS, Client Name: (the "Client") seeks to appoint an authorized Agent of Record to act on behalf of the Client with respect to procurement, placement, and servicing of business-related insurance, benefits, and/or contracting services; and

WHEREAS, Agent Name: (the "Agent") represents that it is duly qualified and authorized to act as Agent of Record for the Client and is capable of performing the services set forth herein.

WHEREAS, the parties desire to set forth the terms and conditions under which the Agent will serve as Agent of Record and provide related services to the Client.

Business Information

Corporation LLC Partnership Sole Proprietor Other:

Authorized Representative

Scope of Work

The Agent shall act as Agent of Record and is authorized to perform the following activities on behalf of the Client in accordance with the terms of this Agreement:

Services expressly include, but are not limited to: requesting and receiving information from carriers and vendors, negotiating terms, making placement recommendations, assisting with renewals, and acting as official point of contact for policy or contract modifications.

Services Authorized

Insurance placement and servicing
Benefit administration
Claims advocacy and support
Contract negotiation and review
Fee-based consulting and advisory
Other:

Payment Terms

Client shall compensate Agent in accordance with the following fee arrangement. Fees are due when invoiced and payable in U.S. dollars unless otherwise agreed in writing.

Unless otherwise stated, Client is responsible for any taxes, assessments, or withholdings arising from payments made hereunder. Agent will provide invoices itemizing services and applicable fees. Disputed invoiced amounts must be submitted in writing within thirty (30) days of receipt; failure to timely dispute constitutes acceptance.

Term and Termination

This Appointment shall commence on Start Date: and shall continue until End Date: , unless earlier terminated in accordance with this Agreement.

Either party may terminate this Appointment without cause by providing written notice to the other party at least days prior to the effective termination date. Termination for cause (including material breach, failure to pay fees, fraud, or loss of required licenses) may be immediate upon written notice.

Upon termination, Agent shall cease representing itself as Agent of Record for the Client and shall promptly deliver to the Client all documents, records, and funds belonging to the Client. Termination shall not relieve Client of obligations to pay fees for services rendered and reimbursable expenses incurred prior to termination.

Confidentiality

Each party acknowledges that it may receive Confidential Information of the other party. "Confidential Information" includes non-public business information, pricing, client lists, policy terms, claims information, and proprietary processes. The receiving party shall (a) hold Confidential Information in strict confidence, (b) use it solely to perform under this Appointment, and (c) not disclose it to third parties except as required by law or with prior written consent.

The confidentiality obligations shall survive termination of this Appointment for the duration specified above.

Authorization and Records

Client hereby authorizes Agent to obtain, review and exchange Client information with carriers, vendors, and service providers to the extent reasonably necessary to carry out the Scope of Work. This authorization includes accessing past and present policy information, claims records, and financial data. Client may revoke this authorization in writing, subject to obligations incurred prior to revocation.

Governing Law; Dispute Resolution

This Appointment shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of law principles. The parties shall first attempt to resolve disputes through good faith negotiation. If unresolved, disputes shall be resolved by binding arbitration administered in the governing jurisdiction, except where injunctive or equitable relief is sought.

Indemnification; Limitation of Liability

Each party agrees to indemnify, defend and hold harmless the other party from and against any third-party claims arising from the indemnifying party's negligent acts, omissions or willful misconduct in performance of this Appointment. Except for liability arising from intentional misconduct or gross negligence, neither party shall be liable for consequential, incidental, or punitive damages.

Notices

All notices required or permitted under this Appointment shall be in writing and delivered to the parties at their addresses below, by hand, certified mail (return receipt requested), or commercial courier.

Entire Agreement; Amendments

This Appointment, including all schedules, exhibits, and attachments hereto, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior or contemporaneous agreements and understandings. No amendment shall be effective unless in writing and signed by authorized representatives of both parties.

Severability; Assignment

If any provision of this Appointment is held unenforceable, the remaining provisions shall remain in full force and effect. Neither party may assign its rights or delegate its obligations under this Appointment without the prior written consent of the other party, except that Agent may assign to an affiliate or successor in interest.

Acknowledgment

By signing below, each party represents and warrants that the person signing has the authority to bind the respective party, that the information provided in this Application is true and correct to the best of the signer's knowledge, and that the party agrees to be bound by the terms and conditions set forth herein.

Sign Now