I hereby authorize SuranceBay, LLC and its general agency customers (the
“Authorized Parties”) to affix or append a copy of my signature, as set
forth below, to any and all required signature fields on forms and
agreements of any insurance carrier (a “Carrier”) designated by me
through the SureLC software or through any other means, including
without limitation, by e-mail or orally. The Authorized Parties shall be
permitted to complete and submit all such forms and agreements on my
behalf for the purpose of becoming authorized to sell Carrier insurance
products. I hereby release, indemnify and hold harmless the Authorized
Parties against any and all claims, demands, losses, damages, and causes
of action, including expenses, costs and reasonable attorneys' fees
which they may sustain or incur as a result of carrying out the
authority granted hereunder. By my signature below, I certify that the
information I have submitted to the Authorized Parties is correct to the
best of my knowledge and acknowledge that I have read and reviewed the
forms and agreements which the Authorized Parties have been authorized
to affix my signature. I agree to indemnify and hold any third party
harmless from and against any and all claims, demands, losses, damages,
and causes of action, including expenses, costs and reasonable
attorneys' fees which such third party may incur as a result of its
reliance on any form or agreement bearing my signature pursuant to this
authorization.