BROKER OF RECORD LETTER

Sample Letter

Prepare on Insured’s Letterhead

To (Insurance Carrier Name) :

Policy Type (Pkg/WC/Etc) :

Policy Number (s) :

Policy Period :

BOR Effective Date :

To Whom It May Concern:

This is to confirm that we have appointed [BROKER NAME] ([BROKER ABBREVIATION]), as our exclusive insurance broker. This appointment will remain in effect until cancelled in writing.

[BROKER ABBREVIATION] is hereby authorized to negotiate directly with any interested company in regards to placement of insurance policies and in changing, increasing, closing, or canceling any of these policies. We understand, however, that they will not have the responsibility for any deficiencies in the insurance program to which this letter applies until they have had a reasonable opportunity to make a review of our firm and to provide us with their recommendations.

This letter also constitutes authority to furnish [BROKER ABBREVIATION] representatives with any information necessary as may be requested as it pertains to our insurance contracts, surveys, and all financial data they may wish to obtain for their study of our present and future requirements in connection with our insurance program.

Sincerely,

_____________________ __________________ ____________