Rollover Agreement Form - Additional Commission Agreement

Rollover Agreement Form | Return to Agency Programs Bulleted List

Additional Commission Agreement between Fulmont Mutual Insurance Company and

________________________________________________ , Fulmont Agent

THIS AGREEMENT, dated this ______day of ______________, _______ between Fulmont Mutual Insurance Company, organized under the Insurance Law of the State of New York, hereinafter called “Fulmont”, and _________________, agent for Fulmont, hereinafter called “Agent”.

NOW THEREFORE: “Fulmont” and “Agent” do hereby agree as follows:

WHEREAS, “Fulmont” has offered to convert a book of business owned by said “Agent” from _________________ to “Fulmont” according to the following terms and conditions:

a. Commission – “Fulmont” will pay the “Agent” an additional rate of _____% on the risks accepted in the above mentioned conversion. The additional commission will be paid only in the first year of conversion – on or about the 15th of the month after the said premium is paid to Fulmont.

b. Term – The policies will be converted at anniversary date on commercial business and at renewal date on personal lines business.

c. Excluded Risks - NONE.

d. Inspections – None at inception date, thereafter prior to end of required policy period.

“Fulmont” will complete the rollover with minimum work and inconvenience to the “Agent”.

The “Agent” will allow a representative of “Fulmont” to gather all necessary data and paperwork to complete the rollover from the files at the agency office – at a time convenient to the “Agent”. Further, the “Agent” will provide “Fulmont” with a bordereau of the book being converted.

The “Agent” agrees to mail the necessary notification when required by statutory law to all insureds subject to the aforementioned conversion or rollover. The “Agent” further agrees that the notification, if required, will meet all of the statutory requirements.

This offer of additional commission may not be used in conjunction with any other agent incentive program that “Fulmont” may offer with the exception of the “Fulmont” Contingent Commission Program and the Agent Retention Program. There will be no compounding of commission except for the normal commission rate established for agents by “Fulmont”.

This agreement is terminated after “Fulmont” has paid the additional commission (according to the commission terms mentioned previously) on all policies accepted on the bordereau of the converted business from ____________________ to “Fulmont”.

_____________________________ Fulmont Mutual Insurance Company

by: __________________________

title: _________________________

On this _____ day of ___________________,

______, before me personally appeared

____________________________________

known to me and known by me to be the

person described above.

____________________________________
Notary Public