NeitClem Producer Agreement

1. Parties

This Producer Agreement is entered into between the licensed insurance producer submitting the Become an Agent application ("Producer," "you," or "your") and NeitClem Wholesale Insurance Brokerage, Inc., DBA Xylem Insurance Services ("NeitClem").

NeitClem is a Fire & Casualty Broker-Agent, Special Lines SL Broker, and Surplus Lines Broker licensed in the State of California, License# 0E24609, located at 7442 North Figueroa Street, Los Angeles, CA 90041.

2. California Fire & Casualty Broker-Agent License

Producer must hold a current California Fire & Casualty Broker-Agent License and provide the name as it appears on the license, the license number, and its expiration date. Producer may submit a copy of the license as evidence of this information.

3. Professional Liability Errors & Omissions Insurance

Producer must maintain Professional Liability Errors & Omissions insurance and provide the insurance company, policy number, expiration date, and limits of liability. Producer may submit a copy of the E&O declarations or certificate as evidence of this coverage.

4. Taxpayer Identification

Producer must provide a Taxpayer Identification Number / Employer Identification Number and indicate the business entity type: Individual, Partnership, Corporation, LLC, Trust, or Other. Individual producers without an EIN may provide a completed IRS Form W-9 instead.

5. Premium Collection & Remittance

You, the Producer and the Insured's designated insurance representative, are responsible for the collection and remittance of all premiums.

Premium payments to NeitClem must be made from your premium trust account only. NeitClem only accepts premium payments from you, the Insured's designated insurance representative, with the exception of payment from a licensed and authorized premium finance company.

Receiving and/or dispersing premium debits and/or credits is your responsibility, other than exceptions imposed by statute.

6. No Flat Cancellations

Once coverage is bound, there are no flat cancellations.

7. Communication with Insureds

NeitClem does not communicate with your insureds, except when required by contract or law.

8. Name on Documents

The name of your organization as it appears on your California Fire & Casualty Broker-Agent License must appear on all documents received from you, and only that name.

9. Regulatory Compliance

NeitClem, like all other licensed Insurance Broker-Agents and Surplus Lines Brokers transacting business in the State of California, is required to adhere to the State of California Insurance Regulations, Rules, and Guidelines.

Insurers frequently request that NeitClem reaffirm its compliance, specifically referring to, but not limited to:

• Fiduciary Responsibilities — California Insurance Code § 1732, § 1733, and § 1734
• Record Retention — California Insurance Code § 1759.3

In turn, NeitClem requests that those entities with whom it transacts business, including your organization, confirm compliance with the State of California Insurance Regulations, Rules, and Guidelines.

10. Required Documentation

You may submit copies of the applicable documents evidencing the information above. These can be attached directly to the Become an Agent application:

• California Fire & Casualty Broker-Agent License
• Professional Liability E&O declarations or certificate of insurance
• IRS Form W-9

11. Acceptance & Execution

This agreement is accepted electronically when you check the Producer Agreement acknowledgment and type your full legal name as your electronic signature on the Become an Agent application. The date, time, and details of your acceptance are recorded with your submission and countersigned by:

NeitClem Wholesale Insurance Brokerage, Inc.
DBA: Xylem Insurance Services
7442 N. Figueroa St
Los Angeles, CA 90041
(323) 258-2600  ·  neitclem@neitclem.com