Agreement for Advanced Insurance Management® Review of Workers' Compensation Premiums

1. Advanced Insurance Management LLC ("A.I.M.") agrees to review Client’s current and prior Workers’ Compensation insurance policies and premiums (collectively referred to as "WC Premiums") to find premium reduction(s), credit(s), premium adjustment(s), overcharges, and/or refund(s) (collectively referred to as "Savings") caused by mistakes in use of classification codes, payroll calculation, Experience Modification Factor computation, and/or other technical factor affecting such premiums. A.I.M. does not guarantee that it will find Savings. All information obtained by AI.M. about Client and Client’s operations shall be treated as confidential information and shall be used by A.I.M. solely in its efforts to produce Workers’ Compensation premium savings. Illinois law governs this agreement.
2. _____________________________________ ("Client") agrees to provide copies to A.I.M., of insurance policies, audits, and related insurance work papers and to request needed materials from insurance companies, agents, and/or rating bureaus, subject to availability, as well as to provide reasonable information about Client’s operations that affect its WC Premiums. Client authorizes A.I.M. to work with Client’s insurance companies, insurance rating organizations, and insurance regulatory agencies to correct any overcharges A.I.M. finds.
3. Client may cancel this agreement by providing written notification to A.I.M. at any time.  However, Client is obligated to pay A.I.M. per the terms of this agreement for any Savings identified by A.I.M. and communicated to Client or to Client's insurers or to insurance rating bureaus prior to such cancellation, if Client subsequently receives such Savings due to the efforts of A.I.M.
4. A.I.M. agrees that it will suspend or discontinue its efforts to obtain Savings for Client if Client so instructs A.I.M. in writing.  However, Client is still responsible for payment of any hourly charges incurred but not yet billed by A.I.M. at the time Client instructs A.I.M. to suspend or discontinue its efforts on behalf of Client.

Client shall pay A.I.M. as follows:

1. Client shall pay A.I.M. an fee of $150 per hour for time spent in the above work.   This will be billed by A.I.M. on a monthly basis.  An initial retainer payment of $__________ is due and payable at the outset of this agreement, and this retainer payment will be credited against the first month's hourly rate billing by A.I.M.
2. If Client realizes Savings for the Current Policy and/or prior policies due to A.I.M.’s Help, Client agrees to additionally pay to A.I.M., a fee equal to 25% of such Savings. Such Savings must be realized without reducing Client’s Workers’ Compensation coverage. Such Savings must also be of a nature that the Client would not have received them without the help of A.I.M. "Current policy" is defined as the policy in effect on the date this agreement is signed. Any Savings on future policies due to the help of A.I.M. generate no fee for A.I.M. Only Savings due to A.I.M.’s efforts, advice, recommendation, and/or assistance (collectively referred to as "Help" or "Helps") shall be considered in computing any fee due.
3. The contingent Fee described in section B. above due A.I.M. only when Savings are actually received. Such contingent fee is due and payable to A.I.M. upon receipt of the Savings. If payment of such fee is not received by A.I.M. within 15 days of Client’s receipt of such Savings, A.I.M. is entitled to add to its fee a late charge of .05% per day of the outstanding fee owed.

By signing below, the parties acknowledge that they have read and understood the above terms.

Accepted:

_________________________________________________/______________________________
Client Company Executive Officer Signature                                 /   Date

For Advanced Insurance Management LLC_______________________________________

© 2006 Advanced Insurance Management LLC