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Fs/f
4.
Independent contractor.
Producer acknowledges
and agrees that it is an independent contrac tor and not an employee of P etFirst.
By accepting any payment of commissions, Broker attests that it is an independent contractor (as such term is defined in
Treasury Regulation Section 1.409A-1(f)(2)) with respect to PetFirst, and acknowledges that it is solely responsible for
payment of all taxes related to any payment of commissions. Broker also releases (to the extent permitted by law) PetFirst
from any and all responsibility for payment of any and all taxes related to any payment of commissions, including, if
applicable, any interest or penalties that may be imposed under statutes, regulations, orders, or rulings governing the
taxation of deferred compensation, including but not limited to Section 409A of the Internal Revenue Code.
5.
Notices. Disclosure. If Producer receives notice of the commencement of any legal, regulatory or administrative proceedings
involving PetFirst or Producer, or if it receives any communication from any Insurance Department or other administrative agency
or any other person identifying a complaint registered against PetFirst or Producer, Producer shall, following receipt of such notice,
immediately notify PetFirst of the proceeding or complaint, and promptly forward any correspondence or necessary files. Producer
shall disclose to each of its clients all compensation including, without limitation, commissions, service fees, and supplemental
compensation that PetFirst pays to Producer or any of Producer's affiliates with respect to the PetFirst Products purchased by
Producer's client. Producer shall provide to a client or prospective client PetFirst's Compensation Notice provided in any PetFirst
bid proposal for such client. PetFirst reserves the right to change the form of the Compensation Notice. PetFirst reserves the right
to disclose to its customers or potential customers the details regarding compensation it may pay to Producer and to Producer's
affiliates under this or any other agreement. Producer shall provide to customers or prospective customers a copy of PetFirst’s
compensation notice provided in any PetFirst bid proposal for such customer or prospective customer. PetFirst reserves the right to
disclose to its customers or potential customers the details regarding compensation it may pay to Producer.
6.
Customer information. Producer agrees to treat all information about individuals who enroll, apply for or purchase PetFirst's
products or services that Producer may have or may obtain in connection with its obligations under the Contract (“Customer
Information”) as confidential. Customer Information may include, but is not limited to, an individual's name, address, social
security number, and any financial or health information relating to the individual. Producer may use Customer Information only for
the purpose of fulfilling its obligations under the Contract and Producer may not disclose Customer Information to anyone other
than the individual to whom the information relates, except as required for Producer to fulfill its obligations under the Contract or as
otherwise directed by PetFirst, or except as expressly required by law. Producer must also ensure that Customer Information is
kept in a secured manner.
7.
Amendments. PetFirst reserves the right to amend this Agreement by providing Producer with thirty (30) days prior
written notice of the change.
8.
Advertising. For the sale or marketing of PetFirst products, Producer shall use only sales material approved in writing
by PetFirst and its legal support from the Metropolitan Life Insurance Company.
9.
Termination. PetFirst may terminate this Agreement at any time for any or no reason. Additionally, this Agreement shall
terminate immediately if (a) Producer is no longer appointed by PetFirst to sell its products; (b) Producer is not licensed by
the applicable state insurance department; (c) Producer breaches any provision of this Agreement; (d) Producer commits or
its agents commit fraud, embezzlement, gross negligence or other legal misconduct. The rights and obligations established
under Sections 3, 5, 6, and 7, hereof, shall survive the termination of this Agreement.
SECTION 3: Signatures
Producer
SSN, Broker Code or License number (For verification purposes only)
Email Address
Commission Payment Street Address
City
State Zip code
First Name (please print)
Middle Name
Last Name
Signature of Producer
Date (mm/dd/yyyy)
Payee
Individual Name/Business Entity to Be Paid
SSN/Tax Payer Identification Number
Broker Code
Vice President
Signature
Name
Katie Blakeley
