Fill and Sign the Insurance Agreement Form

- 1 – INDEPENDENT INSURANCE AGENT INSURANCE AGENT AGREEMENT THIS AGREEMENT made and entered into on the date last written below, by and between __________________ (hereinafter "Employer"), and __________________, an independent Insurance Agent (hereinafter "Insurance Agent"); WHEREAS, the Employer desires to retain the services of Insurance Agent, and Insurance Agent desires to render 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 Insurance Agent, at will, for a term commencing on __________________ , 20 and continuing until terminated in accordance with Section 4 of this agreement. 1.2 Duties . Insurance Agent 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 atte ntion (reasonable periods of illness excepted) to the performance of the duties specified in this agreeme nt. Insurance Agent's duties shall include the following: _________________ _. Insurance Agent further agrees that in all aspects of such work, Insurance Agent shall comply with the policies, standards, regulations of the Employer from time to time establishe d, and shall perform the duties assigned faithfully, intelligently, to the best of his/her ability, and in the best interest of the Employer. SECTION 2 – CONFIDENTIALITY 2.1 Confidentiality . Insurance Agent acknowledges and agrees that all records, lists and information pertaining to clients and files and other Employer data and information relate d to its business (hereinafter collectively "Confidential Information") are valuable assets of the Empl oyer. Except for disclosures required to be made to advance the business of the Employer and information which is a matter of public record, Insurance Agent shall not, during the term of this Agreeme nt or after the termination of this Agreement, disclose any Confidential Information to any pe rson or use any Confidential Information for the benefit of Insurance Agent or any other person, except with the prior written consent of the Employer. Employer understands that certain Confident ial Information may be required to be disclosed to certain individuals: directors, officers, employe es, agents, or advisors (collectively, Representatives) of Insurance Agent. Insurance Agent 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 Insurance Agent on a non-confidential basis, provided that the source of such information was not known by Insurance Agent (after such inquiry as would be reasonable in the circumstances) to be bound by a confidentiality agreement or other legal or contractual obligation of confide ntiality with respect to such information. In the event that Insurance Agent or any of Insurance Agent’s representatives, assigns, or agents are requested or required by law or legal process to disclose any of the Confidential Information, 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 inspecti ons or inquiries by federal or state regulatory agencies to whose jurisdiction Insurance Agent is subjec t and that have the legal right to inspect the files that contain the Confidenti al Information, and Insurance Agent will advise Employer promptly upon such disclosure. 2.2 Return of Documents . Insurance Agent 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 . Insurance Agent agrees that the termination of this Agreement shall not release Insurance Agent 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 Insurance Agent to the Employer, the Employer shall pay to said __________________ the amount of $ per hour week 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. Insurance Agent shall be solely responsible for reporting and paying any such taxes. The Employer shall not provide Insurance Agent with any coverage or participation in the Employer's accident and health insurance, life insurance, disability income insurance, medical expense reim bursement, wage continuation 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. Insurance Agent 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 Insurance Agent. 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 INSURANCE AGENT STATUS 5.1Insurance Agent acknowledges that he/she is an independent Insurance Agent and is not an agent, partner, joint venturer nor employee of Employer. Insurance Agent shall have no authority to bind or otherwise obligate Employer in any manner nor shall Insurance Agent represent to anyone that it has a right to do so. Insurance Agent further agrees that in the event that t he Employer suffers any loss or damage as a result of a violation of this provision Insurance Agent shall indemnify and hold harmless the Employer from any such loss or damage. 5.2 Assignment . The Insurance Agent 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 INSURANCE AGENT 6.1 Insurance Agent represents and warrants to the Employer that there is no employment contra ct or other contractual obligation to which Insurance Agent is subject, which prevents Insurance Agent from entering into this Agreement or from performing fully Insurance Agent's duties under this Agreement. 6.2 Insurance Agent 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. SECTION 7 - INSURANCE 7.1Insurance Agent 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, Insurance Agent's operations in connection with the services or duties described above. This insurance shall include the following coverage(s) that is (are) checked below: - 4 – 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. 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 Insurance Agent or Employer an obligation after termination or expiration of this Agreement shall survive termination or expiration hereof and be binding upon Insurance Agent 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 . _________________ _ EMPLOYER - 5 – _________________ _ INSURANCE AGENT