Mrs. Janica Blackhurst SelectHealth P. O. Box 30192 Salt Lake City, UT 84130-0192
Dear Mrs. Blackhurst:
[name below will be inserted here] hereby designates Lloyd Coleman as Agent of Record, effective August 1, 2017 with respect to the medical and/or dental insurance product(s) purchased from SelectHealth. In making this designation, it is required that you pay any and all commissions and/or fees payable from the effective date forward to the Agent of Record. It is understood that the Agent of Record is the exclusive representative to act on behalf of the client to: 1. Solicit insurance proposals from you, and 2. Review proposals and make recommendations assisting us in achieving our goals. I hereby represent to your firm that in issuing this Agent of Record Letter, the Agent of Record has not given, paid, provided or promised any benefit, inducement, or compensation in any form other than services directly supporting your medical and/or dental insurance product(s). Further, no representation has been made that the Agent of Record can obtain a premium rate more favorable to our company than is available through any other appointed agent for the same coverage, benefit, or program. I understand that the terms and conditions of this appointment will be subject to SelectHealth’s specific contractual requirements, as well as your normal agent appointment procedures. Any questions about our coverage or proposed benefit changes, as well as any fees and commissions, should be directed to:
Lloyd Coleman (801) 571-0817 Clarity Insurance Advisors 8899 S 700 E, Suite 155 Sandy, UT 84070
This Agent of Record Letter rescinds any prior appointments of agent/agency with respect to this coverage and shall remain in effect until revoked or replaced in writing.
Sincerely,
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