Reason Broker of Record Letter

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Reason: Broker of Record Letter


To Whom It May Concern:

This letter authorizes Cook & Associates Insurance Brokers, Inc., as our broker of record.
They are authorized to work with you on all of the requirements connected therewith.

Please accept them in such capacity and provide such information and records or make
such endorsements, alterations and changes as they may request.

This recognition of Cook & Associates Insurance Brokers, Inc. as our broker of record
entitles them to any and all commissions and service allowances paid by your company in
conjunction with the placement, installation and servicing of the above referenced
contract(s) and will become effective______________________________.

The appointment of Cook & Associates Insurance Brokers, Inc. rescinds all previous
appointments and the authority contained herein shall remain in force until such time as
we may otherwise notify you in writing.

Respectfully yours,