Broker Of Record Letter(3) by pptfiles


									                                       Broker of Record Letter

To: Heath XS, LLC /Hallmark
Policy Type:
Policy Number:
Policy Period:


To Whom It May Concern,
This is to inform you that as of today’s date we have appointed                as our exclusive insurance
Broker with respect to all insurance matters pertaining to the casualty insurance placed with your company.
The authority given herewith rescinds all previous appointments. This appointment will remain in effect
until cancelled in writing.

This letter also constitutes authority to furnish           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.


Signature                 Title                       Date

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