November ____, 2004
Exhibit
10.17
![](https://www.sec.gov/Archives/edgar/data/1272957/000101540205001435/logo.jpg)
November
____, 2004
Dear
[Producer]:
Bristol
West Services of California, Inc. ("Bristol") is amending your Producer's
Agreement. Pursuant to paragraphs III (A) and VIII (C) of your Producer's
Agreement, the changes will be effective January 1, 2005.
A revised
Brokerage Agreement that contains all amendments is enclosed. You will see that
the commission structure has changed. Your commission structure is set forth in
Exhibit #1.
As noted
above, the changes are effective January 1, 2005. Solely for our records, we ask
that you sign the revised Brokerage Agreement and return it using the enclosed
pre-addressed envelope by December 15, 2004.
If you
have any questions regarding this letter, please contact Xxxxx Xxxxxx at
0-000-000-0000, ext. 2522.
Sincerely, | |
Bristol
West Insurance | |
Services
of California, Inc. |