Independent Agent Agreement

Contract between General Agent of Insurance Company and Independent Agent

Agreement made on the day of 20 , between of , referred to herein as Agent, and , Inc., a corporation organized and existing under the laws of the state of , with its principal office located at , hereinafter referred to as General Agent.

Whereas, General Agent is engaged in the business of selling insurance (hereinafter called insurance) for , a corporation organized under the laws of the State of , having its principal office at ; and

Whereas, Agent has been engaged in and has had experience in the insurance business; and

Whereas, Agent is willing to be employed by General Agent as an independent contractor/agent, and General Agent is willing to employ Agent in such capacity on the terms as set forth below;

Now, therefore, for the reasons set forth above, and in consideration of the promises of the parties to this Agreement, and other good and valuable consideration, receipt of which is acknowledged, the parties agree as follows:

I. Employment

General Agent employs Agent to sell and solicit insurance products of Acme Insurance Company, and Agent shall devote his or her entire time to the sale and solicitation of such insurance pursuant to this Agreement and shall not represent any other insurance agency without the written consent of General Agent.

II. Independent Contractor

Notwithstanding the foregoing, and anything herein to the contrary, Agent shall be an independent contractor for all purposes. As an independent contractor, Agent has the right to exercise independent judgment as to time, place, and manner of soliciting insurance, servicing policyholders, and otherwise carrying out the provisions of this Agreement.

III. Remittance of Premiums and No Rebate Rule

Agent shall pay over all premiums or advance payments to General Agent as soon as collected. Rebating in any form, directly or indirectly, is prohibited.

IV. Assignment of Territory

Agent shall be permitted to solicit business only in the territory assigned by General Agent. Agent shall not have any exclusive right to any territory assigned under the provisions of this Agreement, nor shall he or she have any claim to commissions on business secured by other agents operating in such territory unless Agent and the other agents have so agreed in writing and a copy of their Agreement shall have been approved and filed with General Agent.

V. Insurance

General agent will pay for Agent’s errors and omission insurance. General Agent will also pay for all costs of the insurance rater used by the General Agent in connection with Agent’s services pursuant to this Agreement.

VI. Salesperson’s Incurring Indebtedness of Liability; When Sales Final

Agent shall not incur indebtedness in the name of General Agent, and shall not sign the name of General Agent to any contract. No sale or contract is binding until written approval of the underwriting department. Agent shall supply General Agent with a list of new policies (in a form acceptable to General Agent) on the day of each month.

VII. Commissions

Agent shall receive a commission of % of the first year's premiums and a renewal commission of % of each payment after the first year. If General Agent shall for any reason refund any premium on which Agent is entitled to a commission under this agreement, Agent shall lose all right to commissions on such premium and shall repay to General Agent on demand the full amount received by him or her on account thereof. Said commissions will be mailed to Agent’s address set forth above on or before the day of each month. No broker fee shall be charged by Agent that exceeds $ .

VIII. Bonuses

A. Percentage of Sales of Agents Sponsored by Agent:

B. Exceptions: Notwithstanding Subparagraph A,

IX. Expenses

A. Agent shall pay $ each year to cover administrative and customer service cost. This expense will be paid from the commissions of Agent for the month following the one year anniversary date of this Agreement. If said commissions are insufficient to make said payment, such insufficiency will be drawn from future commissions until said amount is paid in full.

B. Agent shall also pay General Agent the sum of $ upon the execution of this Contract to cover expenses of General Agent in establishing Agent as an independent agent of General Agent, and to reimburse General Agent in part for payment of the expenses described in Paragraph V and to pay the expenses of Agent’s Voice over Internet Protocol.

C. Agent shall be responsible for all of his/her advertising expenses.

X. Assignment of Contract and Purchase of Renewals

Agent may purchase the rights to all renewal premiums of a policy or premiums for replacement policies by paying General Agent .

XI. Exclusive Representation

Agent will represent General Agent exclusively in the sale and service of insurance. Such exclusive representation shall mean that Agent will not solicit or write policies of insurance in companies that are not acceptable to General Agent.

XI. General Conduct and Representation

Agent will maintain a good reputation in the community which Agent serves and will direct all efforts in the field of insurance toward advancing the business and interest of the General Agent to the best of his/her ability. In the conduct of Agent’s business, Agent will comply with all applicable insurance laws and regulations.

XII. Cancellation

This Agreement shall continue from its effective date until the end of the current year and shall be automatically renewed thereafter from year to year unless sooner canceled. This Agreement shall automatically cancel upon the date Agent's license to act as an Agent for the General Agent is revoked or canceled, or upon Agent's death or retirement. General Agent may also terminate this Agreement without notice for fraud or misconduct on the part of Agent or for the failure of Agent to comply with the applicable insurance laws of the state of or with the regulations of the department or commission of insurance of such state.

XIII. Service to Policyholders upon Cancellation

Upon cancellation of this Agreement, the General Agent retains the right to continue to provide insurance services to any and all customers/policyholders and to continue to solicit such customers/policyholders for additional business.

XIX. Amendments or Modifications

Except as otherwise provided in this Agreement, this Agreement may be changed, altered, or modified only in writing signed by Agent and an officer of the General Agent.

XX. Assignment of Agent’s Rights or Duties

General Agent relies upon Agent's particular personal abilities in carrying out his/her obligations under this Agreement, therefore, no assignment of Agent's rights, responsibilities, or any sums due agent under this Agreement shall be made without prior written consent signed by an officer of the General Agent. Consent to such an assignment will not be unreasonably withheld.

XXI. Manuals, Forms, and Records

In view of the fact that insurance is a closely regulated business, it is understood that it will be necessary for General Agent to provide Agent with certain pertinent manuals, forms, records, and such other materials and supplies as are necessary in the conduct of the business. All such property furnished to Agent by General Agent shall remain the property of General Agent and be returned to it in good condition upon cancellation of this Agreement. General Agent may offer to Agent, from time to time, training, counsel, and guidance based upon General Agent’s accumulated experience in the sale and servicing of business.

XXII. Arbitration

Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect.

WITNESS our signatures as of the day and date first above stated.