INSURANCE BROKERS AGREEMENT

This Agreement is made this ____day of_____________ !""____ By and Bet#een$ ________________________________________%ereinafter referred to as &Bro'er( and$ &E)e*+ti,e -eri.s In*/ & 0os Ange.es Ca.ifornia hereinafter referred to as &Genera. Agent/( 1ITNESSET% 1hereas the a22.i*ant affirming to 3e a d+.y and 2ro2er.y .i*ensed ins+ran*e Bro'er #ithin his tota. area of geogra2hi* .o*ation 4s5 and 1hereas the &Bro'er( is desiro+s of o3taining from &Genera. Agent( the 2.a*ement of Ins+ran*e for the a22.i*ants *+stomers and6or 2rin*i2a.s

T%E GENERA0 AGENT AN7 BROKER %EREB8 AGREE$

ARTIC0E 9$ The GENERA0 AGENT a+thori:es the BROKER to *o..e*t re*ei,e and re*ei2t for 2remi+ms on ins+ran*e tendered 3y the BROKER and a**e2ted 3y the GENERA0 AGENT/ The GENERA0 AGENT sha.. render indi,id+a. 2remi+m 3i..ings for ea*h transa*tion indi*ating the net amo+nt 2re,io+s.y s+3mitted #ith an a22.i*ation/ The BROKER sha.. render 2ayments as 2er the terms of the GENERA0 AGENT in,oi*e/ ARTIC0E !$ The Genera. Agent agrees to 2ay to the BROKER as f+.. *om2ensation for the ins+ran*e #ritings a rate of *ommission from time to time agreed +2on/ The BROKER sha.. 2ay the GENERA0 AGENT a ret+rn *ommission at the same rate on any ret+rn 2remi+m in*.+ding ret+rn 2remi+ms on *an*e..ations ordered or made 3y the GENERA0 AGENT #hether or not the BROKER sha.. ha,e *o..e*ted the 2remi+m for the ins+red/ ARTIC0E ;$ The BROKER +n*onditiona..y g+arantees 2ayment to the GENERA0 AGENT of a.. 2remi+ms d+e as stated in ARTIC0ES 9 < ! a3o,e/ =+rthermore on 2o.i*ies #hi*h are iss+ed s+3>e*t to a+dit and on #hi*h the BROKER or ins+red has arranged 2remi+m finan*ing the BROKER agrees in the e,ent of *an*e..ation of s+*h 2o.i*ies to 3e res2onsi3.e for the amo+nt of the 2ro?rata 2remi+m 3e*oming d+e to the 2remi+m finan*e *om2any +nder 2remi+m finan*ing agreements #here the Com2anys finding on a+dit res+.ts in earned 2remi+m e)*eeding 2ro?rata ret+rn of the finan*ed 2remi+m/ ARTIC0E @$ The BROKER a**e2ts the res2onsi3i.ity for the *o..e*tion of any State or =edera. ta)es S+r2.+s 0ines *harges Bro'er and6or other a22.i*a3.e fees and sha.. remit for s+*h ta)es *harges or fees in a**ordan*e #ith the a**e2ted reg+.ations #ith res2e*t to E)*ess S+r2.+s 0ines o2erations or in a**ordan*e #ith 3i..ing instr+*tions from the GENERA0 AGENT/ ARTIC0E A$ If BROKER is 2.a*ing 3+siness #ith the GENERA0 AGENT #hi*h is dire*ted to him 3y another .ega..y esta3.ished BROKER he a**e2ts f+.. res2onsi3i.ity as if he #ere the originator of s+*h 2.a*ements/ ARTIC0E B$ Nothing in this AGREEMENT sha.. 3e *onstr+ed as .imiting or restri*ting the right of the GENERA0 AGENT to *an*e. any *ontra*ts of ins+ran*e iss+ed +nder this AGREEMENT/ ARTIC0E C$ E)*e2t as other#ise stated herein the BROKER has no a+thority to 3ind or other#ise a**e2t any ris' on 3eha.f of the GENERA0 AGENT/ ARTIC0E D$ The BROKER agrees that it #i.. maintain Errors and Omissions Ins+ran*e *o,erage at a.. times #ith *o,erage .imits of at .east E9 """ """/ The BROKER agrees to 2ro,ide the GENERA0 AGENT 2roof of ins+ran*e at the reF+est of the GENERA0 AGENT and f+rther agrees to 2rom2t.y notify the GENERA0 AGENT if *o,erage is e,er dis*ontin+ed or *an*e.ed/ This Agreement may 3e terminated at any time 3y m+t+a. *onsent/ It may a.so 3e terminated 3y either 2arty at any time #ith or #itho+t *a+se gi,ing to the other 2arty #ritten noti*e at .east thirty 4;"5 days 2rior to desired termination date/ %o#e,er s+*h noti*e sha.. not a22.y to ris's #hi*h ha,e 3een 3o+nd *an*e.ed or are in effe*t at the date of termination of this Agreement/ -age 9 of !

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This Agreement s+2er*edes any and a.. 2re,io+s agreements 3et#een BROKER and GENERA0 AGENT and it may not 3e a.tered or modified e)*e2t in #riting o,er the signat+res of 3oth 2arties hereto/ Any addend+m to this Agreement sha.. a.so reF+ire the signatory of 3oth 2arties thereto/ Termination or revocation of BROKERS licenses as above indicated will automatically suspend this Agreement as respect the placement of insurance business in the geographic areas to which such licensing applies

Signed! At_____________________________ "ate________________ Bro#er $rincipal$____________________________

%eneral Agent! E&ecutive $erils' (nc !))))))))))))))))))))))))))))))) "ate!))))))))))))))))))))))))

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d3a$ E)e*+ti,e -eri.s Ins+ran*e Ser,i*es

ExecutivePerils

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-age ! of !

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