AGREEMENT OF INSURED (JOINT AND SEVERAL, IF MORE THAN ONE) THE UNDERSIGNED INSURED: 1. In consideration of the premium payments being financed and, if applicable, down payment being advanced by LENDER to the Insurance companies listed on the SCHEDULE OF FINANCED POLICIES, or their representative, promises to pay to the order of LENDER the TOTAL OF PAYMENTS to be made in accordance with the PAYMENT SCHEDULE and if applicable, the amount of any down payment advanced by LENDER subject to the provisions set forth in this Agreement. 2. Irrevocably appoints LENDER Attorney-in-Fact with full authority, in the event of default, to (i) cancel the said policies in accordance with the provisions herein, (ii) receive all sums assigned to LENDER and (iii) execute and deliver on behalf of the undersigned all documents, forms and notices relating to the insurance policies listed on the SCHEDULE OF FINANCED POLICIES in furtherance of this Agreement. IMPORTANT NOTICE TO INSURED NOTICE: 1. Do not sign this Agreement before you read it or if it contains any blank spaces. 2. You are entitled to a complete filled-in-copy of this Agreement. 3. Keep your copy of this Agreement to protect your legal rights. 4. You are entitled to a Spanish translation of this Agreement before signing. (Usted tiene derecho a la versión en español de este contrato antes de firmar). NOTICE: See Pages 2 and 3 Additional Important Information. THE INSURED AGREES TO THE PROVISIONS ABOVE AND ON PAGES 2 AND 3 12/27/2007 /s/ R. Jeffrey Taylor | | AGENT OR BROKER Lockton Insurance Agency of Houston-Healthcare BUSINESS ADDRESS Healthcare Division 5847 San Felipe Street, Suite 320 Houston TX 77057-3000 TEL. NO./E-MAIL ADDRESS 713-458-5200 The Undersigned Agent or Broker: 1. Represents and warrants as follows: (a) to the best of the undersigned’s knowledge and belief, the insured’s signature is genuine or, to the extent permitted by applicable Law, the undersigned Agent or Broker has been authorized by the insured to sign this Agreement on their behalf, (b) the insured has received a copy of this Agreement, (c) the scheduled Policies are in full force and effect and the premiums indicated therefore are correct, (d) the insured may cancel all scheduled policies immediately upon request, (e) none of the Policies scheduled in the Agreement are non-cancelable, and (f) the down payment as indicated in Box “B” and installments totaling $ have been collected and are being retained by us. 2. Upon cancellation of any of the scheduled Policies, the undersigned Agent or Broker agrees upon demand to pay to LENDER or its assigns their commission on any unearned premiums applicable to the cancelled Policies. 3. For California business, the undersigned agent will receive from LENDER $ for aiding in administration of premium finance agreement relating to the above premiums. THE AGENT OR BROKER AGREES TO THE PROVISIONS ABOVE AND ON PAGE 3 DATE SIGNATURE AND TITLE OF AGENT OR BROKER |