Standard Broker Fee Agreement
This disclosure was prepared by the California Insurance Commissioner. Please READ IT CAREFULLY!
- Do not sign any broker fee agreement unless all of its blank lines and spaces have been filled-in and you have read this entire document and the agreement carefully.
- Your insurance broker represents you, the consumer, and is entitled to charge a broker fee if he/she chooses. This fee is not set by law, and may be negotiable between you and the broker.
- It is illegal or improper for an insurance broker to charge you a fee for placing coverage solely with the California Automobile Assigned Risk Plan or the California FAIR Plan. Fees may be charged for placement of other coverages.
- Broker fees are often non-refundable even if you cancel your coverage. Refer to your broker fee agreement to see if your broker fee is non-refundable. However, you may be entitled to a full refund of a broker fee if your broker acted incompetently or dishonestly. Unresolved disputes over non-refunded broker fees can be forwarded to the Department of Insurance for review.
- You are entitled to obtain and keep a completed copy of this disclosure and any broker fee agreement you sign.
- Your broker may receive commission from the insurance company(ies) for placing your insurance. This commission may be paid to your broker by the insurance company(ies) in addition to any broker fee you pay.
- If you will be paying your premium in installments to a finance company, by law you must receive a copy of a premium finance disclosure and agreement. Be sure to obtain and read those documents before signing a premium finance agreement. Also, ask the broker if the insurer offers its own installment payment plan. Insurer installment plans are often cheaper than premium financing through a separate premium finance company.
- If your broker is placing automobile coverage, your broker must provide you with a copy of the current Department of Insurance Automobile Insurance pamphlet. If your broker is placing residential coverage, your broker must provide you with a copy of the current Department of Insurance Residential Insurance pamphlet. By signing this disclosure, you acknowledge receipt of the appropriate pamphlet(s).
Client initials: ______
Standard Broker Fee Agreement
- The parties to this agreement are and , License Number .
- CLIENT appoints BROKER as CLIENT'S insurance broker of record.
- This agreement shall become operative on and shall continue in full force until terminated by either party.
- BROKER agrees to represent CLIENT honestly and competently.
- CLIENT agrees to pay BROKER a broker fee for BROKER'S services. The broker fee is
- The broker fee (IS NOT refundable).
- BROKER may in the future charge CLIENT, and CLIENT agrees to pay additional fee(s) for the services listed below. The additional fees and services are:
| Service | Amount |
| Waiver of Subrogation | will be determined by the insurance Company |
| Additional Insured | will be determined by the Insurance Company |
| Certificate of Insurance | $0 |
| Endorsement Fee | $ will be determined |
- Following are the nature and amount of all fees known to BROKER that will be charged by persons other than BROKER or the insurance company in connection with current placement of CLIENT's insurance. These fees are not retained by BROKER.
Client Signature____________________________
Date____________________________
Broker:
