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WIAA Membership & Subproducer Application





Thank you for your interest in working with us! The following documents are required to process your WIAA membership and subproducer appointment:
1. Membership Application
2. Subproducer Marketing Agreement
3. Subproducer Appointment Survey
4. W-9 Form
5. Current E&O declarations page or certificate
6. Current Broker Bond for CA agents
7. Current agency & individual P/C license(s) for all states you wish to write in. WIAA Insurance Services is licensed in CA, AZ, NM, NV, CO, TX and WA.
Allow up to 24 hours for processing.
Agency Information
Company Information
Company Name & DBA
Required
Physical Address
Required
City
Required
State
Required
ZIP / Postal Code
Required
Mailing Address if different
Optional
City, State. ZIP Code
Optional
Primary Phone Number
Required
Alternate Phone Number
Optional
Fax #
Optional
E-Mail Address
Required
Website
Optional
Preferred method of communication
Optional


Date entity was established
Required
/ /
# of Locations
Required
Reasons for joining WIAA
Required
Total staff size
Required
Please list main contact below
Name
Required
License #
Required
Years of Experience
Required
E-Mail Address
Required
Weekly Bulletin E-newsletter?
Required

Membership Dues
Annual Commission
Required
If Other, please specify
Optional
Payment Method
Check (Please make payable to WIAA Group)
Optional
Credit Card
Optional


Please select card type
Optional


Credit Card #
Optional
Expiration Date
Optional
Code
Optional
Print name as it appears on card
Optional
* I authorize Western Insurance Agents Association (WIAA) to initiate scheduled debits for membership dues to my credit card account as indicated above. This authorization will continue until which time I have mailed written notification to WIAA instructing them that I have elected to terminate this consent. I understand that I should allow 30 days from receipt of sent written notification to discontinue the scheduled debits. I also understand that annual membership dues are fully earned at the time of joining or upon annual renewal of membership and no refund is entitled once membership year has commenced.
Signature Authorization
Required
Date
Required
/ /
Note: As a 501(c)6 organization, your dues may be tax deductible as an ordinary business expense.
INSURANCE PROGRAMS: WIAA members become eligible for consideration as sub-producing agencies of the insurance programs offered through WIAA Insurance Services
Subproducer Marketing Agreement
This declarations page with the Subproducer Marketing Agreement provisions and modifications if any issued to become part of the Agreement and completes this Agreement.
Agency Name
Required
Street Address
Required
City, State, Zip
Required
Phone
Required
Fax #
Optional
E-Mail Address
Required
Terms & Conditions
This Agreement is entered into between the insurance agency or brokerage named in the Declarations, hereinafter called “SUBPRODUCER” and Agents Resources, Inc. d/b/a WIAA Insurance Services
Conduct of Business
SUBPRODUCER warrants and represents that SUBPRODUCER holds a currently valid insurance agent’s/broker’s license by or accepted by the State(s) in which risks to be insured under this Agreement are located, and that said license(s) will be maintained in force for the duration of this Agreement; that SUBPRODUCER currently has in force Errors and Omissions insurance coverage with limits not less than $1,000,000 per occurrence; and, that said minimum limits of insurance will be maintained in force for the duration of this Agreement; that
SUBPRODUCER intends to place business in compliance with limits and guidelines as established by WIAA Insurance Services and the companies represented by WIAA Insurance Services.
SUBPRODUCER will maintain membership in the Western Insurance Agents Association (WIAA) for the duration of this Agreement.
SUBPRODUCER is not allowed to broker business without prior approval from WIAA Insurance Services.
SUBPRODUCER agrees to comply with the broker fee requirements and regulations as stated by the Department of Insurance and must fully disclose the broker fee to the insured. SUBPRODUCER understands and agrees that a broker fee will not be charged to any customer on any transaction of Personal Lines insurance business.
SUBPRODUCER agrees that SUBPRODUCER is not authorized in any way to bind risks for any company represented by WIAA Insurance Services, or to act in anyway as an agent of the company or WIAA Insurance Services, or to hold him/herself out as such. SUBPRODUCER further agrees that SUBPRODUCER is not authorized to make, alter, vary or discharge any insurance policy contract, or to extend time for payment of premiums, or to waive or extend any policy or condition, or to incur liability on behalf of WIAA Insurance Services or any company represented by WIAA Insurance Services.
SUBPRODUCER agrees that any advertisement, brochure or marketing document intended for general distribution that utilizes the name, logo or symbol of WIAA Insurance Services or any company represented by WIAA Insurance Services must be submitted to WIAA Insurance Services for written approval prior to use.
SUBPRODUCER understands and agrees that nothing in this Agreement shall be construed as limiting or restricting the right of any company represented by WIAA Insurance Services to cancel or non-renew any policy of insurance issued in accordance with the cancellation or non-renewal provisions contained within any such insurance policy contract and/or for failure to meet on a continuing basis the underwriting requirements.
Commissions
WIAA Insurance Services will pay SUBPRODUCER commissions on all policies at the rates specified in the Commission Schedule(s). WIAA Insurance Services reserves the right to amend commissions. Commission payment will be calculated and paid based on net commissions (commissions on new paid premium less any return commission due) due SUBPRODUCER within 30 days of WIAA Insurance Services’ receipt of the commission from the company. SUBPRODUCER agrees to pay return commission, if any, to WIAA Insurance Services within 30 days following receipt by SUBPRODUCER of the request for return.
Direct Billed Business
All policies issued under this Agreement are direct billed by the company issuing the policy. SUBPRODUCER agrees that any premium received by SUBPRODUCER for policies issued under this Agreement will be held in trust for the company and will be remitted promptly when due.
Ownership of Expirations
Upon termination of this Agreement, the records of the SUBPRODUCER and the use and control of expirations shall remain the property of the SUBPRODUCER for policies issued under the Agreement.
Policyholder’s Designation of SUBPRODUCER
Any request for change or clarification of SUBPRODUCER of Record status must be in writing from the policyholder presented to WIAA Insurance Services All requests for individual policy change of SUBPRODUCER of Record will be honored effective the next regular renewal date of the policy. If guidelines permit, books of existing business may be transferred from one agent/broker to another upon written request by both parties presented to WIAA Insurance Services. Requests for book transfers are effective immediately upon acceptance by WIAA Insurance Services.
Suspension
WIAA Insurance Services may suspend a SUBPRODUCER’s right to submit new business under this Agreement for the period of time necessary to investigate circumstances surrounding any apparent violation of the intent of this Agreement. WIAA Insurance Services will forward written notice of suspension to SUBPRODUCER.
Termination of Agreement
This Agreement takes effect as of the Effective Date shown below and may be terminated: At any time by mutual Agreement. Immediately by either party upon written notice to the other if the other is in default on any of the obligations under this Agreement. By either party upon ninety days written notice to the other. Immediately upon notification from the company by WIAA Insurance Services of the company’s refusal to issue new and/or renewal policies.
After Suspension or Termination
Upon suspension or termination of this Agreement, SUBPRODUCER’s right to submit new applications or place renewals will cease. SUBPRODUCER’s expiring policies will be continued in force.
Other Provisions
Headings
The subject headings of the paragraphs and subparagraphs of Agreement are included for purposes of convenience only, and shall not affect the construction of interpretation of its provisions.
Severability
If any one or more of the provisions of the Agreement shall for any reason by held invalid or unenforceable in whole or in part, such invalidity or unenforceability shall not negate validity or enforceability of any other part of the Agreement.
Notices
All notices, requests, demands, and any other communications under this Agreement shall be in writing and shall be deemed to have been duly given on the date of service if served personally on the party to whom notice is to be given, or in the third day after if mailed to the party to whom notice is to be given, by first class mail, registered or certified, postage prepaid, to the last known address.
Parties to Agreement
Nothing in this Agreement, express or implied, is intended to confer any rights or remedies under or by reason of this Agreement on any person other than the parties to it and their respective successors and assigns, nor is anything in this Agreement intended to relieve or discharge the obligations of liability of any third person to any party to this Agreement, nor shall any provision give any third persons any right of subrogation or action over or against any party to this Agreement.
Assignment
Neither party shall assign its right or duties under this Agreement without the prior written consent of the other party, which consent shall not be unreasonably withheld.
Recovery of Litigation Cost
If any legal action or arbitration or other proceeding is brought for the enforcement of this because of an alleged dispute, breach, default, or misrepresentation in connection with any of the provisions of the Agreement, the successful or prevailing party or parties shall be entitled to recover reasonable attorney’s fees and other costs incurred in that action or proceeding, in addition to any other relief to which they may be entitled.
Hold Harmless
SUBPRODUCER agrees to indemnify and hold harmless WIAA Insurance Services, its parents, subsidiaries and related entities, as well as their directors, employees and agents, from any claim and all causes of action or claims of any type, including costs and attorney’s fees arising out of failure of the SUBPRODUCER to perform the SUBPRODUCER’s duties and responsibilities under this Agreement.
Jurisdiction
This Agreement shall be subject to and construed under the laws of the state of California.
Entire Agreement
This Agreement constitutes the entire Agreement between WIAA Insurance Services and SUBPRODUCER and supersedes all prior and contemporaneous Agreements.
To be completed by SUBPRODUCER
I have read and agree to abide by the Terms & Conditions of this Agreement.
Required
Signature
Required
First Name
Required
Last Name
Required
Title
Required
Date
Required
/ /
Upload W-9 Form
Optional
E&O Dec. Page or Certificate
Optional
Current Broker Bond for CA agents
Optional
Agency & Individual P/C license(s) for all states you wish to write in
Optional
WIAA Insurance Services is licensed in CA, AZ, NM, NV, CO, TX and WA.
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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