Insurance Retention Agreement

INSURANCE RETENTION AGREEMENT

This Insurance Retention Agreement ("Agreement") is made and entered into by and between Insurer Name: and Applicant / Insured Name: with an effective date of: (the Parties agree as follows).

Recitals

WHEREAS the Applicant seeks insurance protection for certain exposures and agrees to retain a portion of risk through a designated self-insured retention or deductible; and

WHEREAS the Insurer is willing to provide policy limits and claims handling services subject to the retention and terms set forth herein;

Definitions

For purposes of this Agreement: "Retention" means the monetary amount that the Applicant shall be responsible to pay or otherwise fund prior to payment by the Insurer. "Loss" means sums paid on account of claims covered by the underlying policy subject to this Agreement.

Applicant / Insured Information

Individual    Corporation    LLC    Partnership    Other

Policy Details and Retention Schedule

From:    To:

Coverage Selection

Select the coverages to which the retention applies:

Liability    Property    Commercial Auto    Professional Liability / Errors & Omissions    Cyber Liability    Umbrella / Excess

Exclusions

The Insurer's obligations under this Agreement exclude losses arising from the following matters unless expressly added by endorsement: willful misconduct by the Insured, criminal acts, fraudulent claims, known prior acts not disclosed to the Insurer, punitive damages where uninsurable by law, and any other exclusion contained in the underlying policy terms. Additional exclusions or amendments are set forth below.

Retention Terms and Claims Handling

1. Retention Applicability: The Applicant shall retain and be responsible for payment of all Losses up to the Retention Amount set forth above for each claim or occurrence, unless otherwise specified in an endorsement.

2. Payment and Funding: The Applicant shall promptly fund defense and indemnity amounts within the Retention upon demand by the Insurer. The Insurer may advance defense costs but shall be subrogated to any rights of recovery to the extent of such advances.

3. Notice and Proof of Loss: The Applicant shall provide written notice of any claim or circumstance reasonably likely to give rise to a claim within the time and manner required by the underlying policy. Failure to provide timely notice shall constitute a breach of this Agreement to the extent prejudice to the Insurer results.

4. Cooperation and Defense: The Applicant shall cooperate with the Insurer in the investigation, settlement, and defense of claims. The Insurer retains the right to manage the defense subject to the Applicant's obligations under the Retention. Allocation of defense costs between covered and non-covered matters shall be made in accordance with recognized allocation principles.

5. Subrogation and Recovery: The Applicant agrees to cooperate in subrogation and recovery efforts and to promptly reimburse the Insurer from recovered amounts for payments made by the Insurer under this Agreement to the extent of such recovery.

Beneficiary Designation

Notices and Claims Contact

Documentation and Reporting

Upon request, the Applicant shall provide proof of payment of amounts within the Retention, copies of paid invoices, and any documentation reasonably requested by the Insurer to substantiate Losses. The Applicant acknowledges that failure to produce required documentation may lead to denial of reimbursement under this Agreement.

Documentation checklist: Proof of payments    Vendor invoices    Photographs / evidence    Police / incident reports

General Provisions

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified in the underlying policy. Any dispute arising out of or relating to this Agreement shall be subject to the exclusive venue stated in the policy unless otherwise agreed in writing.

Entire Agreement and Amendment: This Agreement, together with the underlying policy and any endorsements, constitutes the entire agreement between the parties with respect to the subject matter hereof. This Agreement may not be amended except by a written instrument signed by the Insurer and the Applicant.

Confidentiality: The parties agree to treat claim information and settlement terms as confidential to the extent permitted by law, except as necessary for claims handling, regulatory compliance, or legal process.

Severability: If any provision of this Agreement is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Certification and Acknowledgment

By signing below, the Applicant certifies that all information provided in this Agreement is true and accurate to the best of the Applicant's knowledge, that the Applicant understands the nature and effect of the Retention and its financial responsibility to fund Losses up to the Retention Amount, and that the Applicant agrees to comply with the notice, cooperation, and documentation obligations set forth herein.

Applicant acknowledges and accepts the terms of this Insurance Retention Agreement.

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