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<br />TAXES, REINSURANCE & BROKERAGE <br /> <br />Periodically, in our search \0 find you the most oompetitive insurance products available in <br />the national mlll:ketplace, we incur certain expenses that we must pass on \0 you, the <br />insurance buyer. <br /> <br />The charges ShOWD below were ineluded on your propoiilll, but wib be In addition <br />to prellllums eventuaDy shown on the polley(s).' ,< .~. <br /> <br />, a. Conunissions lQSt l\.S, a ~I! of negotia~ the hJest poBsible insurance <br />premium from the insurance oompany. For example, when negotiating with an <br />und6lWriter for the lowest possible premium after all standard credits have been <br />applied, they may ask for some commission to detennine our seriousness. If we will <br />give up 10 percent, they will give up 20 peroent, producing a 30 percent savingll. <br />However, if our commission drops below our operating expenses, we must ask for <br />reimbursement. <br /> <br />b, Program fees and expenaes incurred in marketing your account through our <br />DlItional network of brolrem (which we will continue \0 bill on an annual basis as long as the <br />contracts remain in effect). <br /> <br /> <br />.. c. Inspection expenses we charge to provide the various insurance companies with the <br />necessary infonnation they need tc allow the maximum credit available for your account <br />according to their underwriting guidelines. <br /> <br />d. Brokerage charges for p Iscing your covCIage with an insurance company for which <br />we are not a designated marketing agent. <br /> <br />e. Certain taxes and fees imposed on us by the originating insurance company. <br /> <br />f. Certain taxes and fees charged to us by the originating broker. <br /> <br />While these charges have been included in your "total annual premium," they are - or may <br />be - in addition to any commissions inherent in any of the contracts shown on the "policy <br />premium summary" sheet - regardless ifwe receive same. State law requires your <br />aclmowledgment of these charges, yolO' acceptance of same, and your agreement that these <br />charges -in your opinion -are reasonable for services rendered. Your signature is required <br />prior to any of tho proposed coverages being effected. <br /> <br />TU~L'----- <br />Signa _. <br />/ . <br />Club: Centerville Lions Club <br /> <br />Date <br /> <br />b ~r.-- 0,/ <br /> <br /> <br />37 <br />