| AGENCY CLUSTER PROFILE Use this form to evaluate rate potential cluster partners. Before entering into a cluster agreement with anyone, have them fill out this worksheet . This will help you decide if the prospective agency is compatible with your goals and will bring something to your cluster arrangement. The profile is in-depth, but you will find it worthwhile. AGENCY / CLUSTER PROFILE Name: ________________________________________________________________ 1. Previous Year Current Year Forecast Written Premium $______________ $______________ $______________ Gross Commission $______________ $______________ $______________ 2. Estimated Agency Mix of Business - Property & Casualty Lines Previous Year Current Year Forecast Fire & Allied _____________% _____________% _____________% Marine _____________% _____________% _____________% General Liability _____________% _____________% _____________% Crime/Fidelity/Glass _____________% _____________% _____________% SMP & BOP _____________% _____________% _____________% Commercial Auto _____________% _____________% _____________% Workers Comp _____________% _____________% _____________% Personal Auto _____________% _____________% _____________% Homeowners _____________% _____________% _____________% All Other Lines _____________% _____________% _____________% Total 100.0 % 100.0 % 100.0 % 3. Estimated Agency Loss Ratio Previous Year Current Year Personal Lines _____________% _____________% Commercial Lines _____________% _____________% Life/Health _____________% _____________% 4. Total Number of: Personal Lines Accounts _____________ Personal Lines Policies _____________ Commercial Lines Accounts _____________ Commercial Lines Policies _____________ Life/Health Accounts _____________ Life/Health Policies _____________ 5. Commercial Accounts - Five Largest - Written Premium - __________________________________________
- __________________________________________
- __________________________________________
- __________________________________________
- __________________________________________
6. Staff Breakdown - Total Number - Personal Lines Customer Service Representative or Underwriter _____________
- Personal Lines Support Clerk _____________
- Commercial Lines Customer Service Representative or Underwriter _____________
- Commercial Placer _____________
- Commercial Support Clerk _____________
- Life/Health Customer Service Representative or Underwriter _____________
- Receptionist - Secretary _____________
- Accounting or Billing Clerk _____________
- Outside Sales Personnel _____________
1. Principals Principal Principal Principal Time Breakdown (1) (2) (3) Administrative ______% ______% ______% Sales ______% ______% ______% Written Premium Directly Handled $______ $_______ $_______ 2. Non-Principal Producers Salaried Producers Written Premium Gross Commission (1)___________ $______________ $______________ (2)___________ $______________ $______________ (3)___________ $______________ $______________ Commissioned Producers Written Premium Gross Commission (1)___________ $______________ $______________ (2)___________ $______________ $______________ (3)___________ $______________ $______________ NOTE: If an employee or producer works in more than one area above, allocate the percentage of time devoted to each area. 7. What companies do you represent? Use estimated number if you do not have current information. Name Written Premium Gross Commission (1)_______________ $______________ $______________ (2)_______________ $______________ $______________ (3)_______________ $______________ $______________ (4)_______________ $______________ $______________ (5)_______________ $______________ $______________ (6)_______________ $______________ $______________ (7)_______________ $______________ $______________ (8)_______________ $______________ $______________ All Others $______________ $______________ TOTAL $______________ $______________ 8. Is your agency automated? If so, what computer hardware do you have? 9. Did you design your own software or did you buy it from a vendor? (Also please comment on functions performed.) 10. Are you interfaced with any carrier? If so, which one(s) and for what lines of insurance? 11. Do you consider yourself to be particularly competent in a specific field, such as aircraft, risk management, and so on? 12. Do you perform any special services for clients, such as self-insurance administration, risk management services, and so on? 13. What are the major functions you would like the cluster to perform for you, in order of importance, "A" being most important? A. __________________________________________________________________________ B. __________________________________________________________________________ C. __________________________________________________________________________ D. __________________________________________________________________________ E. __________________________________________________________________________ F. __________________________________________________________________________ 14. What concerns/reservations do you have about a cluster relationship? 15. If you, as the principal, are 60 years of age or older, have you made any arrangements for the perpetuation of your agency? If so, what sort of arrangements have you made? 16. What are the ages of all the principals in your agency and how long has each principal been with the agency? Age Duration A. __________ _______________ B. __________ __________________ C. __________ __________________ 17. Do you own your office building? How many square feet of space? 18. Do you have a formal written business or marketing plan? If so, may we see them? 19. How many years have you been using a formal written business plan and have you generally met the objectives you have set for your agency? 20. Comments: 21. Are there any major capital financing obligations? If so, please list and describe: With Original Amount Monthly Whom Amount Owed Payment 22. Are there any unusual or outstanding contracts or agreements? 23. What staff and equipment do you plan/wish to bring to the cluster with you? 24. Do you have any past (within the past 12 months) receivable or company payable problems? If so, please describe: Please attach copies of your most recent balance sheet and profit and loss statement. If you do not have either or both, kindly advise and we will send you a form to use. INTENT TO ENTER INTO A CLUSTER AGREEMENT This agreement form shou1d be signed by anyone with whom you are interested in entering a cluster. The form can and should be modified to reflect your cluster's particular attributes. This form will help weed out the "windowshoppers". You should use this form to make sure no agency wastes your time in inquiring about a cluster arrangement-but you should have an attorney review it before using the form. INTENT TO ENTER INTO A CLUSTER AGREEMENT (SAMPLE) On a non-binding basis, I (we) agree to enter into an agreement to participate in a cluster group of agencies and to share pertinent information with the other members of the cluster group. I agree to abide by the following basic premises: 1. Three-year commitment to participate in the cluster. 2. One-year notice of my intent to withdraw from the cluster. 3. All Personal Lines are to be handled by the cluster staff. 4. The cluster will do all direct mail activity and will provide a soliciting Sales Center and a telemarketing unit. 5. All Commercial applications, requests for quotes, placement, and so on, will be handled by the cluster. I agree to fill out applications as required and to do a risk inspection. 6. Cluster members will be required to use the cluster logo, but may use their own trade name. 7. The cluster will do all purchasing centrally on behalf of the members. 8. No agreements, contracts, or so on will be individually entered into without the approval of the cluster. 9. The cluster will do all billing, maintain all current accounts, and account to all of the individual member agencies on at least a monthly basis. I will adhere to all cluster work processing procedures and standards. I will follow up on all leads generated for me by the cluster. I agree to utilize promotional materials developed for me by the cluster. I agree to devote time to the cluster in management and training activity as needed. Agency Principal Cluster Representative CLUSTER MEMBER AGREEMENT This is an example of the kind of contract participating cluster agencies will sign. You should have your attorney draw up a similar contract more adequately reflecting your cluster's operations. Remember, you must have an attorney draw up the contract. The following is only a guideline, and is not to be used as the actual contract. CLUSTER MEMBER AGREEMENT (SAMPLE) [member name and mailing address] SECTION 1--WHAT THIS AGREEMENT COVERS; NAME UNDER WHICH WE OPERATE, AND LOCATION 1.1 What this agreement covers-Under this agreement, [cluster name] agrees to provide your agency with services according to the terms and conditions outlined in this agreement. 1.2 In this agreement, the words "You" and "Your" refer to your agency and the words "We" and "Our" refer to [cluster name]; a [definition] corporation with its principal office located at: [address] and doing business under the name [cluster name]. SECTION 2--LENGTH OF AGREEMENT 2.1 Initial term-This agreement will become effective on the date indicated at the end of this agreement. It will continue for a period of three years, unless terminated sooner according to the terms described in Section 6, "Conditions of Termination." 2.2 Extension-If you have performed your contractual obligations and are not in default under this agreement, this agreement will be extended for successive three-year periods. If you want an extension, you may be required at that time to execute the then-current form of agreement being used. If you do not want an extension, you must notify us in writing twelve months before the agreement expires. SECTION 3--OUR SERVICES TO MEMBERS We will provide you with a number of services lo help you operate your agency more efficiently and effectively. We may derive revenue from your use of these services. These services include, but are not limited to: 3.1 Insurance products, programs, and markets-We will provide you with products, programs, and markets that you may use only in selling directly to your existing and prospective clients. 3.2 Financial services-We will provide you with cash-management services, accounting and financial record-keeping, and other related facilities. 3.3 Our marks and symbols-We will give you the right to use our marks to identify your agency and broker services. a. You are obligated to use, in accordance with our specifications, our identifying marks in all of your written communication with insurance companies, clients, and prospective clients. b. You are obligated to require that insurance companies use, in accordance with our specifications, our identifying marks in writing the name of your agency on any communications. c. Your right to use our symbol and marks is not exclusive. They remain our property at all times and your use inures to the benefit of us. We may use them in operating a business itself or in granting licenses. d. You agree to notify us immediately of any lawsuit or legal action arising from your use of our marks. We will indemnify you against any costs incurred in defense or payment of judgments resulting from such claims. We shall have the exclusive right to control all litigation relating to the marks and to take whatever action is deemed necessary to protect them. You agree to cooperate with us in protecting the marks and to notify us of any apparent infringement coming to your attention. 3.4 Consultation-Our staff and individuals recommended by us will be available to you for consultation on insurance programs, underwriting, placement, insurance compa
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