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__________, California Department of Insurance License Number _______________ ("BROKER"). 2. CUSTOMER appoints BROKER as CUSTOMER’S insurance broker of record. Broker agrees to transact insurance on behalf of the CUSTOMER. 3. This agreement shall become operative on ______________(date), and shall continue in full force until terminated by either party. 4. BROKER agrees to provide the following services: [ ]; PROVIDED, HOWEVER, that Broker makes no representation or warranty regarding: (a) .

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