BROKER OF RECORD LETTER

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					                      ***REMOVE THESE THREE LINES***
                     SAMPLE BROKER OF RECORD LETTER
             PLEASE COPY or TYPE ON YOUR COMPANY LETTERHEAD




(Date)



(insurance company name)
c/o Caldwell & Associates Insurance Services, Inc.
1173 S. 250 W., #306
St. George, UT 84770


RE: Broker's Letter of Authorization
Policy # (insert policy number)
Policy Period: (insert policy period)

To Whom it May Concern:

This confirms that, as of ___/___/___, we have appointed Caldwell & Associates
Insurance Services, Inc. as our exclusive insurance broker with respect to the above
referenced policy(ies). The appointment of Caldwell & Associates Insurance Services,
Inc. rescinds all previous appointments, and the authority contained herein shall
remain in full force until cancelled in writing.

Caldwell & Associates Insurance Services, Inc. is hereby authorized to negotiate
directly with any interested company as respects changes in existing insurance
policies and in closing, changing, increasing, or canceling insurance carrier under
temporary binders or cover notes.

This letter also constitutes your authority to furnish Caldwell & Associates Insurance
Services, Inc. representatives with all information they may request as it pertains to
our insurance contracts, rates, rating schedules, surveys, reserves, retentions, and all
other financial data they may wish to obtain for their study of our present and future
requirements in connection with the insurance program to which this letter applies.

Sincerely,


___________________________
(Name & Title)