Independent Producer Commission Schedule - Securian Dental

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$H:\ISPS\arpeggio reports\Directories\International ... - Securian Dental$

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Securian Life Insurance Company Securian Agent Appointments 730 South Broadway Gilbert, MN 55741 Fax: 1‐866‐440‐8787 Toll‐free: 1‐866‐201‐1818 Option 2 SecurianAgentAppointments@SecurianDental.com INDEPENDENT PRODUCER AGREEMENT Insurance Agent (“Producer”) Social Security Number Residence Street Address City, State, Zip Insurance Agency (“Producer’s” Agency) Tax Identification Number Business Street Address City, State, Zip This Agreement is made by the above-named Producer (also “you,” “your”, or “yours”) and Securian Life Insurance Company, a Minnesota corporation (the “Company”). 1. APPOINTMENT: The Company appoints and authorizes you, as an independent contractor, to solicit the sale of and sell the Company’s group dental insurance policies listed in the Company’s Commission Schedule provided to you (the “Policies”) according to the terms hereof within the territory assigned to you in the Commission Schedule. This territory is not assigned exclusively to you. 2. DECARE Analytics: You acknowledge that the Company has designated DeCare Analytics (the “Consulting Company”) as its designee to perform certain obligations of the Company under this Agreement. You agree to perform your duties hereunder pursuant to the direction of and respond to the inquiries from the Consulting Company as if such directions and inquiries were received from the Company. 3. RESPONSIBILITIES: (a) You are authorized: (1) to collect initial premiums for the Policies made payable to the Company; and (2) to remit these initial premiums in full immediately to the Company or its designee without making any deductions therefrom. Premium must be only in the form of check, draft, or money order made payable to the Company. You should never accept cash or deposit an initial premium check, draft or money order to your personal or business account. (b) All premiums and any other funds due the Company which come into your possession are received in a fiduciary capacity only, and you will handle such premiums and other funds in accordance with law, and you will remit such premiums and other funds immediately to the Company. SDS-IPAGRMT REV 7_2011 1
(c) You will: (1) promote the sale of the Policies according to the Company’s underwriting guidelines which are communicated to you; (2) strive to achieve an underwriting profit on the Policies sold by you; (3) meet in a manner fully consistent with (1) and (2) of this Section 3(c) any sales quotas set for you by the Company. (d) You will conduct your business affairs in a highly responsible and reputable manner designed to further the interests of the Company. (e) While this Agreement is in effect, you will maintain errors and omissions insurance with limits of liability and deductible amounts, and issued by a carrier, acceptable to the Company. (f) Neither the Company nor the Consulting Company is liable to you or to any other person for any expenses you incur or for damages of any kind or nature caused by you, and you will defend and protect the Company, the Consulting Company and their affiliates, and hold the Company, the Consulting Company and their affiliates, harmless against the claim or demand of any person for damages by reason of any willful or unauthorized or negligent act or omission of yours. (g) You shall not be liable to the Company, the Consulting Company nor any other person, for any expenses the Company or the Consulting Company incurs or for damages of any kind or nature caused by an employee or agent of the Company or the Consulting Company. The Company and the Consulting Company will indemnify and defend you against the claim or demand of any person for damages by reason of any willful or unauthorized or negligent act or omission of the Company or the Consulting Company or an employee or agent of the Company or the Consulting Company. 4. LIMITS OF AUTHORITY: (a) If you desire to place advertising which names the Company, you must first receive the written approval of the Company or its designee. (b) You have no authority to modify or waive any term of any insurance application, Policy, or underwriting guideline or rate pertaining to a Policy. (c) You may not bind the Company on any type of contract other than the Policies, or do any other thing on behalf of the Company not expressly authorized herein. 5. PROCEDURE: (a) The Company or its designee will bill policyholders directly and will collect from policyholders all premiums subsequent to the initial premium paid in connection with any issued Policy, and all such premiums will be payable by the policyholder directly to the Company or its designee. You will strive to ensure that all premium payments made by policyholders, subsequent to the initial premium payment, are paid directly to the Company or its designee. You will service all Policies sold by or referred to you in a manner calculated to maintain friendly relations among policyholders, you and the Company. SDS-IPAGRMT REV 7_2011 2
Page 1: Securian Independent Producer Appoi
Page 5 and 6: eturns on terminated Policies; (3)
Page 7 and 8: IN WITNESS WHEREOF, you and, by the
Page 9 and 10: HIPAA BUSINESS ASSOCIATE ADDENDUM T
Page 11 and 12: mutually agreed upon period of time
Page 13 and 14: 4.6 Indemnity. Business Associate w
Page 15 and 16: Any fee for providing such electron
Page 17 and 18: Independent Producer Data Sheet Sec
Page 19 and 20: Form W-9 Request for Taxpayer (Rev.
Page 21 and 22: Form W-9 (Rev. 11-2005) Page 3 Gene
Page 23 and 24: Assignment of Commissions Securian
Page 25: Commission Reports User Request For

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