WillComply - Application

Apply for access

You can apply for WillComply access using the form below. Enter your company information.

Step 1 - Enter your contact information

First name:

Last name:

Title:

Company name:

Address 1:

Address 2:

City:

State:

Zip code:

E-mail address:

Phone:

Fax:

Web site address (URL):

Step 2 - Billing address

Same as above

Address 1:

Address 2:

City:

State:

Zip code:

Step 3 - Enter your company information

FEIN number:

License number:

Name of E & O carrier:

Limits carried:

Date coverage expires:

Step 4 - Attach a copy of your Dec page

Dec page of E & O:

Step 5 - WillComply Agreement

Printable Agreement

WILLCOMPLY, LLC
FILING AGENT STANDARD AGENCY AGREEMENT

This Agreement made between You (“Client”) and WillComply, LLC, an Ohio corporation (“Filing Agent”).

WHEREAS, Client is required to remit and file reports and certain taxes and other amounts to applicable state regulatory authorities; and WHEREAS, Client has requested of Filing Agent, and Filing Agent has agreed, to perform certain administrative filing duties under the terms and conditions set forth herein.

NOW THEREFORE, in consideration of the representations, covenants and conditions herein set forth, the parties agree as follows:
AGREEMENT

1. Client Duties. Client hereby agrees that it will:

(a) verify proper wording on all insurance policies written to be acknowledged by the state:
(b) submit notification and necessary forms as required by each state in which a filing is to be made in a timely manner to Filing Agent within the specified time noted within the Willcomply, LLC website.
(c) collect tax money and remit to Filing Agent; and
(d) be responsible for all fines and penalties issued by State regulatory authorities for any late filings.

2. Filing Agent’s Duties. Filing Agent hereby agrees that it will:

(a) maintain its surplus lines license during the term and will provide written evidence thereof to Client upon request, and provide copies of the renewed license and the agency tax identification number;
(b) submit policies of insurance written by or through Client to the applicable state regulatory agencies on a timely basis..
(c) remit to the applicable state regulatory agency all required taxes, fees.

3. Compensation. Client shall pay Filing Agent the amounts and in the manner set forth on the Willcomply, LLC website for all services performed by Filing Agent hereunder.

4. Licenses; Good Standing. Filing Agent and Client each represent to the other that they are licensed by all applicable regulatory authorities in any State where they hold themselves as licensed to conduct business, and each is in good standing under the laws of such State and is not under supervision or subject to sanctions or restriction by any authority of any such State, or is under investigation for noncompliance with the rules and regulations of any such authority. Neither is a party to or subject to the provisions of any contract or other restriction which would be violated or breached by performance of the terms and conditions of this Agreement.

5. Independent Contractor. Filing Agent and Client are independent contractors and neither intends to create any partnership, joint venture, employment or agency relationship. Each will be solely responsible for their own taxes of any type, including social security taxes, workers’ compensation taxes or costs, unemployment compensation taxes or costs or any other similar taxes, costs or charges or any other taxes or charges related to compensation and performance of services. Neither will have the right to bind the other by contract, to transact business, or to make any promises or representations on the other’s behalf.

6. Indemnity. Client and Filing Agent each agree to indemnify and hold the other harmless from each and every claim or related error or omission, however caused, by or related to the acts of the other or their officers, directors, agents, principals or employees. Each party also agrees to defend any such claim or disbursements, damages, fines, penalties or other expenses incurred by the other party in connection with such claim. This indemnity and hold harmless agreement shall remain in full force and effect with respect to all such acts or omissions which occur prior to termination of this Agreement.

7. Confidentiality. The parties acknowledge that certain Client’s and Filing Agent’s data or other material relating to their respective businesses is confidential or proprietary. Neither party shall use, copy, sell, assign, transfer, distribute, reveal, disclose to others or in any way exploit for its own benefit any Proprietary Information of the other. In addition, each party agrees that it shall not disclose, nor cause the other to disclose, information relating to any transaction, consumer, customer, or person in violation of the privacy provisions of the Gramm-Leach-Bliley act of 1999 (the “Act”), codified at 15 U.S.C § 6801 et. seq., and each party warrants that its policies, business practices, and methodologies are, to the extent required or forseeably required, in compliance with any and all relevant portions of the Act.

8. Term and Terminations: Payment of Fees. This Agreement may be terminated by either party, with or without cause, upon written notice to the other stating when termination shall become effective, which date shall not be less than thirty (30) days from the date of such notice. Fees are due to Filing Agent for all services rendered through the date of termination.

9. Notices. All notices and other communications hereunder shall be given in writing and shall be deemed to have been duly given and effective: (i) upon receipt if delivered in person or via facsimile, (ii) one day after deposit prepaid with a national overnight express delivery service, or (iii) three days after deposit in the United States mail. Either party may change the following contact information upon written notice to the other party. Notices shall be delivered or transmitted to Client at their submitted mailing address.

If to Filing Agent:

26451 Curtiss Wright Parkway
Suite 103
Richmond Heights, Ohio 44143
Phone: 800-937-3497 Fax: 888-291-1382

10. Severability. If any provision of this Agreement is held to be inapplicable or unenforceable, then such provision shall be construed, as nearly as possible, to reflect the intentions of the parties with the other provisions remaining in full force and effect and the balance of provisions shall remain unaffected, unless Filing Agent’s obligations hereunder are materially impaired, in which even Filing Agent reserves the right to terminate this Agreement.

11. Governing Law; Venue and Statute of Limitations. The laws of the State of Ohio shall govern the construction and interpretation of this Agreement, without regard to the conflict of laws or choice of laws provisions thereof. Venue in any action brought with respect to this Agreement shall be in Cuyahoga County, Ohio, and each party consents to the jurisdiction of the courts sitting therein. Except as otherwise provided in the Agreement, and unless prohibited by law, any controversy, claim or dispute must be brought by Client within one (1) year of the date Client is entitled to assert any such claim.

12. Dispute Resolution. If any claim, controversy or dispute between the Parties their agents, employees, officers, directors, or affiliated agent (“Dispute”) (including whether a particular dispute is subject to arbitration as provided hereunder) cannot be settled through negotiation, it shall be resolved by binding arbitration conducted in the Cleveland, Ohio offices of Judicial Arbitration & Mediation Services, Inc. before a single neutral arbitrator. Any award rendered shall be limited to actual damages sustained by the party in whose favor the judgment is rendered, and no consequential, incidental, punitive, exemplary or special damages shall be awarded except in connection with a breach of confidentiality obligations. The arbitrator’s award shall be final, non-appealable and binding and may be enforced in any court of competent jurisdiction.

CLIENT ACKNOWLEDGES AND AGREES THAT THIS ARBITRATION PROVISION CONSTITUTES A WAIVER OF ANY RIGHT TO LOST PROFITS, PUNITIVE, EXEMPLARY, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR TREBLE DAMAGES (“DISCLAIMED DAMAGES”), AND A JURY TRIAL. IF FOR ANY REASON THIS ARBITRATION CLAUSE IS DEEMED INAPPLICABLE OR INVALID, BROKER CLIENT WAIVES ANY CLAIMS TO RECOVER DISCLAIMED DAMAGES

13. Attorney’s Fees. If either party shall commence legal action to specifically enforce or otherwise seek redress under or for breach of this Agreement, the prevailing party in such action shall be entitled to recover its costs and reasonable attorneys’ fees therein, including costs and fees incurred in any appellate proceeding.

14. Entire Agreement. This Agreement (and all Exhibits) represents the final and entire agreement between Client and Filing Agent and governs the services described herein and shall supersede any other agreements between the parties regarding the subject matter herein. Any amendments to the Agreement must be in writing and signed by an authorized representative of Client and Filing Agent. Filing Agent’s failure at any time to require strict performance by Client shall not waive or reduce Filing Agent’s right to thereafter require strict compliance with any provisions of the Agreement.

By clicking on 'I accept' below you are agreeing to the terms stated above.