PURPOSE: This regulation provides for Producer Service Agreements. (1) Producer Service Agreements.

1. (A) The form set forth in Exhibit A is approved for use as specified in section 375.116, RSMo. Substantially equivalent forms may be used where they contain other provisions and do not affect the content of Exhibit A. The Producer Service Agreement, which is included herein, must be a separate document from any other form or contract.
2. (B) Each Producer Service Agreement may cover multiple contracts of insurance negotiated or procured for the same insured or prospective insured where the insurance producer’s compensation falls within the requirements of section 375.116.3, RSMo. Each insurance producer shall retain one (1) copy of the Producer Service Agreement in his/her office for three (3) years and deliver one (1) copy to the insured.
3. (C) The Producer Service Agreement shall contain a list of the policies it covers. Exhibit A Missouri Producer Service Agreement
4. 1. The undersigned insured hereby engages the services of _______________, a licensed Missouri insurance producer, license #___________, for the purpose of securing, negotiating and procuring the placement of the following described insurance coverages and to assist the undersigned in the preparation of any and all applications, underwriting data, and other information required by an insurer for the purposes of issuing an insurance policy within this state. The insurance coverage requested is: (Here describe in detail the coverage to be effected.)
5. 2. The undersigned insured authorizes the insurance producer to commit to a maximum premium of not more than ____________ ______________ for the above-stated coverage(s). (If multiple contracts of insurance are to be procured for the same insured or prospective insured, a separate maximum may be stated for each contract covered by this agreement.) The undersigned insured agrees to pay as compensation to the insurance producer, above and in addition to the commission received from the insurer, for the various services of the insurance producer a fee of not more than $________________________. (If multiple contracts of insurance are to be procured for the same insured or prospective insured, a separate producer fee may be stated for each contract covered by this agreement.)
6. 3. A brief description of those services performed and not described in paragraph 1. above is:_____________________________________

This agreement is in furtherance of section 375.116, RSMo, and Missouri Department of Insurance Regulation 20 CSR 700-1.100.

Dated: (Insured)

Dated: (Insurance Producer) AUTHORITY: sections 374.045, RSMo 2000 and 375.071–375.136, RSMo 2000 and Supp. 2001.* This rule was previously filed as 4 CSR 190-12.080. Original rule filed Dec. 23, 1975, effective Jan. 2, 1976. Amended: Filed Oct. 14, 1981, effective Jan. 15, 1982. Amended: Filed Jan. 17, 1986, effective June 28, 1986. Amended: Filed Oct. 15, 1996, effective May 30, 1997. Amended: Filed April 12, 1999, effective Nov. 30, 1999. Amended: Filed July 12, 2002, effective Feb. 28, 2003. *Original authority: 374.045, RSMo 1967, amended 1993, 1995 and 375.071–375.136, see Revised Statutes of the State of Missouri, 2000 and Cumulative Supplement, 2001 and 2002.