Retail brokers and agencies: complete and electronically sign the Klein Risk brokerage agreement below to access our wholesale excess and umbrella markets. No PDF to print, scan or mail.
Parties
Klein Insurance Consulting, LLC and Coastal Risk Specialists, LLC (together “Klein Risk”) and the licensed insurance broker submitting this form (“Broker”).
Klein Risk
1 Claridge Dr., Suite 916
Verona, NJ 07044
(888) 305-6303
Version
Broker Agreement, updated 1-1-23. Effective as of the date of your electronic signature below.
In connection with KLEIN RISK placing said policies of insurance, KLEIN RISK agrees to the following and makes the following representations and warranties:
KLEIN RISK has relied upon the following material representations and warranties in entering into this Agreement.
Broker is authorized to issue certificates of insurance under the following procedures:
Broker is a retail broker representing the insured and no other broker is due commission. In certain limited instances KLEIN RISK may permit Broker to serve as a wholesale broker, provided:
Wherefore, the Parties agree to be bound as of the effective date of this Agreement. Submit the information below to execute the Producer Agreement.