Document:

EX-10.4

Exhibit 10.4

ISO MASTER AGREEMENT —  PROPERTY/CASUALTY INSURER

January 2005 Edition

Agreement made this       day of                , 200   between Insurance Services Office, Inc., with
offices at 545 Washington Boulevard, Jersey City, New Jersey 07310-1686 on behalf of itself, its
subsidiaries and affiliates (“ISO”®) and                 having offices at
                and all its affiliates and subsidiaries that provide property/casualty
insurance, unless excluded on an attached Schedule A (collectively referred to herein as
“Licensee”).

In consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS:

a. “Agreement” means this agreement and all Exhibits, Annex(es) and Supplement(s).

b. “Confidential Information” means any non-public information of either party including but not
limited to, agenda and minutes of ISO panels.

c. “Product” or “Products” means any and all works, materials, and data, distributed by ISO or by a
third party licensor of ISO, in any form, format or media (including but not limited to paper,
electronic media and all forms of electronic delivery) including but not limited to manuals, forms
and endorsements, circulars, actuarial studies, loss costs, statistical plans, database outputs,
data compilations and software, and their derivatives that are proprietary to and/or copyrighted or
copyrightable by ISO or proprietary to and/or copyrighted or copyrightable by a third party
licensor of ISO and lawfully licensed to ISO for distribution by ISO and are applicable to the
services and jurisdictions for the lines of insurance or subdivisions thereof, as indicated in the
Supplements.

d. “Supplements” means the Participation Supplement for each line of insurance (the
“Participation Supplements”) and all Product Supplements attached to this Agreement and
incorporated by reference herein.

e. “Territory” The states, jurisdictions or territories of the United States of America, as
licensed herein.

2. PARTICIPATION:

a. To the extent indicated by Licensee on any Participation Supplement, Licensee agrees to
participate with ISO as defined in ISO’s Certificate of Incorporation and By-laws and as set out in
the Participation Supplements. Licensee agrees to abide by any rules or procedures duly adopted by
the Board of Directors of ISO as they apply to ISO participation and this Agreement. Licensee will
be promptly notified of and provided with any modifications or updates to said rules or procedures.
Licensee acknowledges that it is not required to license or use any Product filed or issued by
ISO, except as may be required by law or regulation, and Licensee shall not state or in any way
suggest or represent to any entity that it is or has been required to do so.

b. By selecting participation for Statistical Agent Service in the Participation Supplement,
Licensee agrees to report its statistical data to ISO in accordance with ISO’s applicable
statistical plans, calls for statistics and related requirements. Licensee agrees that ISO has the
right to use said data in developing loss costs and other products, provided that such use does not
reveal Licensee’s individual information.

3. LICENSE:

Provided that Licensee:

a. has completed the appropriate Participation Supplement(s) and/or all applicable Product
Supplement(s); and

b. continues to abide by the terms of this Agreement and the Supplements for the services,
Territory and lines of insurance, or subdivisions thereof, pertaining to the Products licensed
hereunder;

ISO grants to Licensee a non-exclusive, non-transferable license to use in the Territory the
Products which are obtained directly from ISO, or from a third party licensed by ISO to distribute
them to Licensee, solely for Licensee’s property/casualty insurance or reinsurance business.
Licensee may copy or reproduce the Product(s) at its premises as permitted in Section 6 below, but
may not use a third party to do so unless that third party is licensed by ISO to supply the
Product(s) and Licensee has confirmed with ISO that the third party is, in fact, licensed to do so.
Except as may be permitted under Sections 5. and 6. of this Agreement or under any Supplement to
this Agreement, Licensee agrees to restrict access to all Products only to those employees of
Licensee who have a need to use them solely for purposes of Licensee’s property/casualty insurance
or reinsurance business (“authorized employees”). Access to some Products may be limited to
certain employees or other authorized users as identified on the Product Supplement. Except as may
be specifically permitted herein, neither Licensee, nor its employees, nor any users authorized by
the Supplements, shall sell, transfer, distribute, publish, disclose, display or otherwise make the
Product(s) or any of the information therein available, in whole or in part, to any other person or
entity, without the express written consent of ISO.

 

 

For the sole purpose of verifying Licensee’s compliance with this Agreement, ISO may require, on
at least ten (10) days prior notice, an examination and copying of any and all information, books
of account, records, documents, operations and other materials under the control of the Licensee,
and other related entities, which contain records of Licensee’s use of the Products in accordance
with this Agreement. All such documents shall be kept available by Licensee for at least three
(3) years after the period to which they relate. ISO may exercise this right once in any twelve
(12) month period. The audit will be conducted by ISO or its authorized representatives.

In the event Licensee fails to satisfy any of the conditions specified above, ISO may immediately
cease providing Products to Licensee and may terminate access to the Products and thereafter
notify Licensee of same.

4. TERM AND TERMINATION:

This Agreement is effective on the date specified above and shall remain in force until terminated.

a. ISO may terminate this Agreement and/or any Supplement(s) as follows:

(1) if Licensee materially violates any term or condition of this Agreement or any
Supplement(s) and fails to cure said violation within thirty (30) days following receipt of
notice thereof from ISO. In such event, ISO may cease providing the Product(s) to Licensee
unless and until Licensee cures said breach; or

(2) if Licensee defaults in the payment of any fee(s) due under this license with ten (10)
days prior notice ; or

(3) if ISO makes a business decision to discontinue any Product(s) and/or the maintenance
and support of any Product(s) licensed hereunder, provided, however, that ISO shall provide
Licensee with at least ninety (90) days notice of any such discontinuance, and Licensee may
continue to use the discontinued Product subject to the provisions of section 4.e. below; or

(4) if ISO makes a business decision to discontinue participation for any line of insurance,
or subdivision thereof, Territory or service, provided, however, that ISO shall provide
Licensee with at least one hundred eighty (180) days notice of any such discontinuance; or

(5) upon the effective date of legislation, regulation or judicial ruling or decision
requiring ISO to discontinue participation for any line of insurance, or subdivision
thereof, Territory or service, or discontinue providing any Product(s); or

(6)immediately if Licensee (i) terminates or suspends its business; (ii) becomes subject to
any bankruptcy or insolvency proceeding under federal or state law; or (iii) becomes
insolvent or becomes subject to direct control by a trustee, receiver or similar authority;
or

(7) for any other reason, upon one hundred eighty (180) days written notice to Licensee.

	b.	 	Licensee may terminate any Participation Supplement, or portion thereof, effective at the
end of a calendar quarter by providing ISO with sixty (60) days written notice prior to end of
the quarter.
	 
	c.	 	Licensee may terminate this agreement and any Product Supplement, or portion thereof:

(1) if ISO terminates or suspends its business; or

(2) if ISO becomes subject to any bankruptcy or insolvency proceeding under federal or state
law; or

(3) if ISO becomes insolvent or becomes subject to direct control by a trustee, receiver or
similar authority; or

(4) for any other reason, upon one hundred eighty (180) days written notice to ISO.

d. In the event of termination including expiration of this Agreement or any Supplements, ISO shall
have the right to cease providing Products to Licensee and terminate Licensee’s access to
Product(s), and Licensee shall immediately discontinue use of the Products, and at ISO’s option:

(1) return to ISO all applicable Products provided, including all manuals, associated
documentation and any copies thereof; or

(2) destroy the applicable Products, including all manuals, associated documentation and any
copies thereof; and

(3) certify in writing signed by an officer of Licensee that they have been so returned or
destroyed.

e. ISO may, in certain circumstances and at its sole discretion, decide to permit Licensee to
continue to use a Product during a transition period (specified below) after the termination of
this Agreement in its entirety or a termination of that portion of this Agreement applicable to
that Product. If Licensee requests such permission, and ISO agrees, then Licensee must:

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(1) execute an ISO Transitional License; and

(2) pay all Transition License fees.

Licensee acknowledges and understands that during the transition period, which shall not
exceed three (3) years, Licensee shall not be licensed to use any update to any terminated
Product(s) nor shall Licensee receive any maintenance or other services related to the
terminated Product(s). If Licensee executes a Transitional License, and pays the
appropriate fees, Licensee shall not be required to return or destroy the Product(s), as
required under section 4.d., until the expiration or termination of the Transition License.

f. Termination under this Section 4. shall not relieve Licensee of its obligations to ISO regarding
participation for the period during which such participation existed or regarding property or
copyright as specified in Sections 2., 9. and 10. In the event of termination as a result of
Licensee’s breach of its obligations under this Agreement, Licensee shall continue to be obligated
for any payments due up to the effective date of termination.

g. If the license to use any Product provided to Licensee electronically is terminated by ISO under
Section 4.a.(1) or (2) or is terminated by Licensee, Licensee will be liable and charged for
payment of all applicable termination charges related thereto.

h. Termination of this Agreement and/or any Supplement(s) shall be in addition to and not in lieu
of any other remedies available to ISO.

5. RESTRICTION AGAINST TRANSFER OF CONFIDENTIAL INFORMATION: Licensee shall not disclose
or release any ISO Confidential Information which is disclosed to Licensee either (i) in a writing
or other tangible form or (ii) orally, to any third party except with ISO’s prior written consent,
unless compelled to do so by legal process. In such case, Licensee shall give ISO reasonable and
sufficient notice to allow ISO to take action to protect its confidential information and trade
secrets. Licensee shall treat ISO Confidential Information in the same manner and with the same
protections and safeguards as Licensee protects and safeguards its own confidential information and
trade secrets.

	a.	 	ISO agrees that statistical information provided by Licensee shall be considered Licensee’s
confidential information, and ISO shall not release any such information to any third party
without Licensee’s prior written consent, except to appropriate insurance regulators as part
of provision of statistical services (if such services are requested by Licensee), unless
compelled to do so by legal process.

	b.	 	ISO and Licensee acknowledge that much, if not all, of the material and information which has
or will come into their possession from the other party pursuant to this Agreement consists of
confidential and proprietary information, nonpublic personal information or software of the
disclosing party and its affiliates, agents, Licensees or third parties (“Confidential
Information”). The party receiving such Confidential Information agrees to hold it in
strictest confidence and agrees not to release or disclose such Confidential Information to
any individual or entity, whether employee, subcontractor, or subcontractor employee, except
that the receiving party may disclose such information to its employees who are necessarily
involved in the performance of the recipient’s obligations hereunder and have agreed in
writing to keep the information confidential to protect the disclosing party’s interests.

	c.	 	The party receiving Confidential Information further agrees not to (i) use the Confidential
Information for its own benefit or for the benefit of any third parties, other than for the
performance of its obligations under this Agreement, and (ii) release or disclose the
Confidential Information to any other entity, either during the term or after the termination
of this Agreement. In the event of any breach of this confidentiality obligation or of the
obligations relative to the rights to products and services pursuant to this Agreement, or any
product developed or delivered in providing Services, the party receiving the Confidential
Information acknowledges that the disclosing party may have no adequate remedy at law, since
the harm caused by such a breach could not be easily measured and compensated for in the form
of damages.

	d.	 	The party receiving the Confidential Information shall be solely responsible for maintaining
the security of such Confidential Information and for complying with all federal, state,
provincial and local laws, regulations, or other requirements including the Gramm-Leach-Bliley
Act of 1999, 15 U.S.C., Section 6801, as amended from time to time governing the privacy,
confidentiality and non-disclosure of such information.

	e.	 	The foregoing obligations shall not apply to any information which: a) is or becomes known
publicly through no fault of the receiving party; or b) is acquired or learned by the
receiving party from a third party entitled to disclose it; or c) is already known to the
receiving party before receipt from the disclosing party as shown by the receiving party’s
written records; or d) is independently developed by the receiving party, as shown by the
receiving party’s written records; or e) must be disclosed by operation of law.

	f.	 	The foregoing obligations of each party shall survive the termination or expiration of this
agreement.

6. RESTRICTION AGAINST COPYING OR REDISTRIBUTING THE PRODUCT(S): Except as otherwise
provided in this Agreement, the Product(s) licensed hereunder may not be copied, reproduced,
redistributed, sold, filed or used in any manner, without the written permission of ISO or, if the
Product or the portion thereof to be copied, distributed or used is proprietary to a third party,
the permission of that third party. Licensee must receive ISO’s written permission prior to
making a Product(s) available in electronic 

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format including but not limited to via the Internet, extranet, local area network, wide area
network or similar technology and Licensee agrees to pay any associated fees.

Subject to the above and any additional limitations identified below or in the Supplement(s),
permission is hereby granted to reproduce and redistribute copies and extracts of the Products and
the information therein:

a. in any format, to Licensee’s authorized employees;

b. in paper format only to Licensee’s insurance agents and insureds, solely for use in conjunction
with specific policies quoted and/or underwritten by Licensee;

c. in paper format only, to attorneys, independent claims adjusters, loss control consultants and
premium auditors, solely for use in conjunction with work being performed on Licensee’s behalf;

d. to all other consultants, vendors and other third parties, so long as the consultants, vendors
and third parties are licensed by ISO to use the Product solely to provide a product or service to
Licensee;

e. in any format, for the sole purpose of making a filing with insurance regulators, and related
regulatory matters.

Licensee agrees to comply with ISO’s security requirements associated with such availability of
Products. Licensee also agrees to reproduce ISO’s copyright notice, or any applicable third party’s
copyright notice, in any permitted copies, modifications or partial
copies of the
 Product(s) that
Licensee makes.

To the extent Licensee wishes to distribute the Product(s), in whole or in part to any entity not
specifically listed in sections 6.a. through 6.e. above, Licensee must receive ISO’s prior written
permission. ISO may require Licensee to comply with specific security requirements and/or pay
additional fees as a condition of such permission.

Licensee agrees that, to the extent it modifies any Product(s), it is solely responsible for
ensuring that, if required, the modified Product(s) is approved by applicable insurance regulators
for Licensee’s use. Licensee further acknowledges that ISO is not required to provide services or
assistance with respect to modified Products, and that, if ISO agrees to provide such services or
assistance, Licensee may be required to pay consulting fees to ISO.

7. FEES:

Licensee agrees to pay ISO the following fees:

a. Participation Service Fees: Licensee agrees to pay ISO all fees invoiced for participation with
ISO, applicable to the services, Territories and lines of insurance or subdivisions thereof for
which Licensee’s ISO participation applies, as indicated in the Participation Supplement(s),
according to the policies and procedures set forth in the then-current edition of ISO’s
“Participation Billing” booklet.

b. Product Fees: Licensee agrees to pay ISO all fees invoiced for Products within thirty (30)
days of receipt of the invoice. Fees are nonrefundable unless otherwise indicated in writing. The
fee for the initial term for each Product licensed after the effective date of this Agreement is
indicated on the applicable Product Supplement. ISO reserves the right to amend the fees due on
prior notice to Licensee. Licensee shall have thirty (30) days from the date of any renewal notice
or notice of a change in fees to advise ISO in writing of its intent to make adjustments in its
order for the Product(s).

Licensee shall be responsible for payment of fees for all participation services and Products
licensed, regardless of whether Licensee actually uses any or all such Products or services. ISO
reserves the right to amend the fees due on prior notice to Licensee. Except for taxes based on
ISO’s income, Licensee shall be responsible for payment to ISO of all federal, state and local
sales, excise, use or similar taxes in connection with Licensee’s licensing or use of the
Product(s) licensed hereunder. Licensee shall pay ISO interest on all charges not paid within
thirty (30) days at the rate of one percent (1%) per month or the maximum interest permitted by
law, whichever is less.

If ISO terminates the Agreement, in whole or part, pursuant to Sections 4.a. (1) or (2) above, ISO
will reinstate distribution of and/or access to Product(s) only after Licensee pays all outstanding
charges, including any interest and administrative costs that ISO may impose, and all charges
incurred by ISO in disconnecting and reconnecting Licensee access to the Product(s), if applicable.

c. For any Product(s) which will be provided to Licensee electronically, Licensee, at Licensee’s
expense must: (i) provide all necessary Licensee equipment and appropriate interfacing devices; and
(ii) pay for all costs to connect to an ISO-provided connect point or designated node, if
necessary.

8. SECURITY REQUIREMENTS:

a. Licensee agrees to comply with the following security requirements for any Products licensed
hereunder.

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b. Licensee agrees that it will not attempt to circumvent any security measures contained within or
associated with any Product licensed hereunder. Licensee shall not attempt to decompile, reverse
engineer, or otherwise disassemble or obtain the source code of any Product provided hereunder.

c. To the extent a Product licensed hereunder is accessed electronically Third-party software,
sometimes called “spyware”, can infect a user’s computer and capture data without permission.
ISO is not responsible if any confidential data of Licensee or its agents is compromised in
this manner. In order to protect its own data, ISO reserves the right, without prior notice,
to suspend access to any ISO web application by any user or agent whose computer is infected in
this manner until the infection is removed. ISO will make reasonable efforts to notify the
Licensee beforehand, but circumstances may require prompt action.

d. Passwords. For those Products designated on the Supplement(s) as requiring a password, ISO will
assign unique sign-on IDs and passwords, and Licensee and its employees shall only access the
Product(s) through use of the assigned sign-on IDs and passwords, which must be kept confidential.
Each ID will be for the personal use of a single employee only. Licensee shall not distribute or
divulge a valid sign-on ID and/or password to anyone except to its employees, unless otherwise
permitted in the Supplement(s) or in a separate writing by ISO. Licensee is responsible for all
charges as described in the Supplement(s) as they relate to the use and activity charged to
Licensee’s sign-on IDs. ISO retains the right to change any sign-on ID and/or password at its
discretion and notify Licensee sufficiently in advance so as not to interfere with Licensee’s
authorized continuous use of the Product(s). ISO also agrees to promptly change the password upon
Licensee’s request. Access to products which require a password must be discontinued
simultaneously: (i) for any employee, with the end of that employee’s employment with Licensee; and
(ii) for any other user authorized by the Supplement(s), or otherwise authorized by ISO in writing,
with the end of that user’s relationship with Licensee. Licensee shall be liable, and indemnify
ISO, for all fees and all loss or damage caused by or resulting from the continued use of Licensee
sign-on ID(s) and password(s) by terminated employees or unauthorized users.

9. ACKNOWLEDGEMENT OF ISO INTELLECTUAL PROPERTY: Licensee acknowledges that ISO claims
ownership of and a copyright in the Products and shall not contest or dispute, and waives any
defense concerning, any valid ownership or copyright claim made by ISO in the Products. ISO is the
owner or authorized licensee of all proprietary information contained in the Products and has the
right to grant Licensee the license to use the Products in accordance with this Agreement without
violating any law, rule or regulation. Licensee agrees not to take any action that would in any
way impair, jeopardize, be inconsistent with, or violate ISO’s ownership of the Product(s) or any
valid ISO copyright. ISO’s claims of copyright relate to all Products provided to Licensee
pursuant to this Agreement, unless it is stated in the Supplement(s), or on the Product itself,
that a Product is copyrighted by or proprietary to a third party. All applicable rights to patents,
copyrights, trademarks and trade secrets in the Products, and any modifications made to the
Products, and in the information therein, shall remain in ISO or the applicable third party.
Licensee agrees that such third parties are third-party beneficiaries of this Agreement and are
entitled to enforce their rights hereunder against Licensee. Nothing in this Agreement shall be
construed as granting to Licensee any right, title or interest in or to any patent, trademark,
copyright or other right of ISO or the applicable third party. Licensee warrants and represents
that it will take all reasonable steps necessary to protect and preserve the Product(s) and the
interests and rights of ISO and any applicable third parties therein, including appropriate action
by instruction or agreement with its employees or other authorized users permitted access to the
Products.

10. REQUIRED COPYRIGHT NOTICE:

a. If Product(s) are reprinted, copied or otherwise used in full, copies must reflect the copyright
notice actually shown on the Product(s).

b. If Product(s) are reprinted, copied or otherwise used in part, the following legend must appear
at the bottom of each page so used:

“Includes copyrighted material of Insurance Services Office, Inc. with its permission.” If the
material to be reprinted, copied or otherwise used is copyrighted by a third party, Licensee must
obtain permission of the copyright owner to so use the material, and abide by any requirements set
forth by the third party.

11. LIMITATION ON WARRANTIES; NO LIABILITIES: OTHER THAN THOSE REPRESENTATIONS OR
WARRANTIES SPECIFICALLY SET FORTH HEREIN, ISO MAKES NO REPRESENTATIONS, COVENANTS OR WARRANTIES OF
ANY KIND, EITHER EXPRESS OR IMPLIED, WITH RESPECT TO THE PRODUCTS, INCLUDING BUT NOT LIMITED TO
WARRANTIES OF CONDITION, QUALITY, DURABILITY, SUITABILITY, MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE, OR IN RESPECT OF ANY WARRANTY ARISING BY STATUTE OR OTHERWISE IN LAW OR FROM A
COURSE OF DEALING OR USAGE OF TRADE. IF THE FOREGOING LIMITATION IS HELD TO BE UNENFORCEABLE,
ISO’S LIABILITY SHALL NOT EXCEED THE AMOUNT PAID TO ISO FOR THE LICENSE TO USE THE PRODUCT DURING
THE TWELVE MONTH PERIOD PRECEDING THE RESPECTIVE EVENT(S) GIVING RISE TO SUCH LIABILITY OR
OBLIGATION, AND SHALL NOT INCLUDE ANY PARTICIPATION FEES PAID TO ISO. FOR ALL PRODUCTS WHERE
LICENSEE PAYS FOR THE PRODUCT ON A TRANSACTION BASIS, ISO’S LIABILITY SHALL BE LIMITED TO THE
AMOUNT PAID FOR THE SPECIFIC TRANSACTION GIVING RISE TO SUCH LIABILITY OR OBLIGATION. THE
INFORMATION INCLUDED IN THE PRODUCT(S) MAY BE STATISTICAL SAMPLES AND/OR ACTUARIAL CALCULATIONS,
AND ISO MAKES NO WARRANTIES OR

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REPRESENTATIONS, EITHER EXPRESS OR IMPLIED, THAT THE PRODUCTS WILL ACCURATELY REFLECT, PREDICT OR
RESEMBLE EXPERIENCE FOR THE ENTIRE INSURANCE INDUSTRY OR ANY INSURER(S). ALL ISO SERVICES AND
PRODUCTS ARE ADVISORY AND ARE PROVIDED AS IS. ISO DOES NOT WARRANT THE COMPLETENESS, ACCURACY OR
CURRENCY OF THE PRODUCT OR THE INFORMATION CONTAINED THEREIN. ISO SHALL HAVE NO LIABILITY FOR
CONCLUSIONS THAT MAY BE REACHED BY THE LICENSEE.

Except as provided herein, neither ISO, its directors, officers, employees, agents, or participants
shall be liable to Licensee, nor to anyone else, for any loss or damage of any kind and however
caused, including without limitation, any special, incidental, indirect, consequential or exemplary
damages, losses or expenses, including, without limitation, lost profits, failure to realize
expected savings or any other commercial or economic loss of any kind resulting from Licensee’s use
of the Product(s). Licensee agrees to indemnify and hold ISO harmless from and against any loss,
damage, claim, suit or expense, including reasonable attorney’s fees, arising out of or relating to
the improper use of the Product(s) by Licensee. With respect to Product(s) provided to Licensee
electronically, ISO does not warrant that access will be available during all scheduled hours of
operation. ISO represents it will use best efforts to correct any ISO system malfunction causing
any unavailability in a timely manner. Oral statements do not constitute warranties, shall not be
relied upon by Licensee, and are not part of this Agreement.

12. INDEMNIFICATION BY ISO: Licensee shall notify ISO promptly of any claim that any
Product, or Licensee’s use of any Product, is improper or illegal or violates the rights of any
third party. ISO agrees to defend, indemnify and hold Licensee harmless from and against any loss,
cost, expense, damage or liability resulting from any claim or suit brought against Licensee based
on an allegation that a Product, when properly used as permitted herein, infringes any United
States copyright, trademark, patent or other intellectual property right, provided that Licensee,
within fifteen (15) days of receipt of notice of any such alleged infringement, notifies ISO of
such allegation in writing. ISO shall have the sole right to conduct the defense of any such claim
or suit and all negotiations for its settlement or compromise, unless otherwise mutually agreed to
in writing by the parties hereto. In the event that Licensee’s use of any Product is held to
constitute an infringement and use of that Product is permanently enjoined, ISO shall, at its
option and expense, either:

a. procure for Licensee the right to continue using such Product; or

b. modify such Product to become non-infringing; or

c. replace such Product with an equally suitable, compatible and functionally equivalent
non-infringing product; or if the foregoing is unavailable

d. grant Licensee a pro-rata refund of the charges paid for such Product provided that prior to
paying such refund Licensee returns such Product and all copies and partial copies thereof to ISO.

Should Licensee learn of the infringement of any Product(s) licensed under this Agreement, Licensee
shall promptly advise ISO in writing, providing ISO with any available evidence of infringement. In
any such infringement suit as ISO may determine to institute to enforce its intellectual property
rights, Licensee shall, at the request and expense of ISO, cooperate with ISO in all reasonable
respects, including having its employees with relevant information provide such information to ISO
and testify when requested by ISO and make available to ISO any relevant records, papers,
information and the like.

13. PROPER NOTICE: Unless otherwise provided in this Agreement, all notices, directions,
instructions, orders, requests, demands, acknowledgments and other communications required or
permitted to be given hereunder shall be in writing, addressed to the parties at their respective
addresses set forth at the beginning of this Agreement or to such other addresses as one party may
furnish in writing to the other, and shall be deemed properly given or made when:

a. delivered personally;

b. made or given by prepaid telex, telegraph, facsimile or telecopy; or

c. received by first class mail, postage prepaid, or upon the expiration of three (3) days after
any such notice, direction, instruction, order, request, demand, acknowledgment or other
communication is deposited in the United States mail for transmission by first class mail, postage
prepaid, whichever shall occur first.

14. SURVIVAL OF TERMS: The terms and conditions of Sections 4 through 7 and 9 through 16
shall survive the termination of this Agreement.

15. CHOICE OF LAW AND EXCLUSIVE JURISDICTION AND VENUE FOR ADJUDICATING ANY DISPUTE: This
Agreement shall be governed by and construed in accordance with the laws of the State of New York
as an agreement made and wholly performed therein. Any litigation, action, or proceeding arising
out of any dispute concerning or otherwise attempting to enforce, interpret, or remedy any breach
of this Agreement shall be brought only in a court of competent jurisdiction (whether federal or
state) sitting within the State and County of New York. The parties irrevocably and
unconditionally (a) submit to personal jurisdiction in the State of New York and

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consent to venue in the County of New York with respect to any such action, (b) waive any objection
to the jurisdiction and venue in the State and County of New York, and (c) agree not to plead or
claim in any such court that any such suit, action or proceeding has been brought in an
inconvenient forum.

16. COUNTERPARTS. This Agreement may be executed in separate counterparts, each such
counterpart being deemed to be an original instrument, and all such counterparts shall together
constitute the same agreement.

17. GENERAL: This Agreement, and the Annexes and Supplement(s), contains the entire
agreement of the parties, shall prevail over and supersedes all previous written and oral
agreements or terms and conditions of any purchase order, acknowledgement form, or other
instrument, or any promotional, marketing, or advertising materials (including without limitation
any memorandums of understanding and written proposals) with respect to the subject matter hereof.
This Agreement, and the Annexes and Supplements, may be changed or modified only in a writing
signed by both parties. If any provision of this Agreement is determined to be invalid under any
applicable statute or rule of law, it is, to the extent invalid, deemed to be omitted and the
remaining provisions of the Agreement shall continue in full force and effect. The failure or
delay of either party to insist upon the performance of any of the terms of this Agreement in any
one or more instances will not be construed as a waiver or relinquishment of the future performance
of any such term, and the obligation of the parties with respect to any such future performance
will continue in full force and effect. This Agreement inures to the benefit of and is binding
upon the successors and assigns of ISO and may be assigned by ISO to any of its subsidiaries,
affiliates, or related companies. It likewise inures to the benefit of Licensee, but no interest
herein shall be transferred or assigned in any manner by Licensee.

This contract is not valid against ISO unless and until executed by the appropriate ISO officer or
authorized representative at the appropriate ISO home office.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement by their authorized
representatives as of the day and year first written above.

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 
	 	INSURANCE SERVICES OFFICE, INC.
	on behalf of itself, its subsidiaries and affiliates (Licensee)	on behalf of itself, its subsidiaries and affiliates (ISO)
	 
	 	 	 	 	 	 
	Signed:

	 

	 	Signed:
	 

	 
	 	 	 	 	 	 
	Name:

	 

	 	Name:
	 

	 
	 	 	 	 	 	 
	Title:

	 

	 	Title:
	 

	 
	 	 	 	 	 	 
	Date:

	 

	 	Date:
	 

January 2005 Master Agreement — Property Casualty Insurers.doc

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	Participation Supplement

	Line of Insurance Original or Revision Orginal Participation for This Line of insurance

	Deletion Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 50 orDeletlon DelellonollhlsUne0,^^

Rutes Forms
Effective Date

	MonthDayYear            I
\ Type of            State Filing
\ Participation \ Services \ Authorization \
\ |cmcM|i»r«nm

	01 02 03 04 05 06 07 08 09

Alabama 01

Alaska 54

	Arizona 02 i

Arkansas 03

	California 04

	Colorado            OS ___•i — n

Connecticut 06 ‘ 7

	Delaware 07 S

Dist. of Col. 08 g

Flolida 09 7 »

Georgia 10 §

Idaho 11 §

Illinois 12

	Indiana 13 •|

Iowa 14 &

Kansas 15 7

	Kentucky 16 s

Louisiana 17 §

Maine 1 8 1

	Maryland 19 o

Michigan 21 ^

Minnesota 22 s

Mississippi 23 3

	Missouri 24 1

	Montana 25 i

Nebraska 26 1

	Nevada 27 mm s

New Hampshire 28

	New Jersey 29

	New Mexico 30

	New York’ 31

	North Carolina” 32

North Dakota 33

	Ohio 34

	Oklahoma 35

	Oregon 38

	Pennsylvania 37

	Puerto Rico 58

	Rhode Island 38

	South Carolina 39

	South Dakota 40

	Tennessee 41

	Texas 42 mm t

Utah 43

	Vermont 44

	Virginia 45

	Washington 46

	West Virginia 47

	Wisconsin 48

	_
Wyoming 49
Virgin Islands 60

Guam 61

	Please complete a separate form lor Texas Statistical Agent Service. FA lor New York rules
Is applicable to classlllcation and territories only.

	Note: In certain states, services may be limited by law.

Rating Information Services correspond to loss/cost and rules services.

 

 

	Participation Supplement

	Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 010

	PBRSOlSrAL AUTOMOBILE I n I | or Deletion
Revised  Participation lor this Line of Insurance

	(L T AT3TT PTTV jfco T3TTVQTnAT T» A TUT AntT\w 1 U            WCKUIUH
(. L ilAPJLUJJ. I PC Jrxl I BIOJiJ-i lJ.flJVLeHj.CiJ CODEI            I            II O Deletion ol this Una of Insurance

r~~| I r~| I r~~| ILine Services Rules Forms
Effective Date            I            I            I I            II            I            i—i     
       i—i

	Month            Day            Year            I | | .................................... |

	~S.CONT\Typeof\ State \ Filing \ \\ <j> \ \
Participation \ Services \ Authorization \ \ \ \ \ \
MiaeM Pi,r il.lal .. \ ........................... \ \ % \ \

	\v\M

	\ \A\v\

	Alaska 54 u            u            U

Arizona 02 :* 4

Arkansas 03 mm 8’ V

California 04 mm ^ a 1 $
mm

Colorado            OS •1 mm &

Connecticut 08 « w            x

Delaware 07 i 1

	Dist. ol Col. 08 §

Florida 09 mm d- 1 IT

Georgia 1 0 I § %

D)
Idaho 11 8

	Illinois 12 mm § i

Indiana 13 <? •g 5

	Iowa 14 a            a            g.

Kansas 15 sr 7

	Kentucky 16 I 1 1.

	Louisiana 17 0 0 S

Maine 18 I «• $

Maryland 19 5 n            o

Michigan 21 o-

Minnesota 22 1 s 8

	Mississippi 23 0 s 0

	Missouri 24 p %

Montana 25 §: 3;

Nebraska 28 •a            f 1

	Nevada 27 s 3 ?

New Hampshire 28

	New Jersey 29

	New Mexico 30 .

	New York 31

	North Dakota 33

	Ohio 34

	Oklahoma 35

	Oregon 36

	Pennsylvania 37

	Puerto Rico 58

	Rhode Island 38

	South Carolina 39

	South Dakota 40

	Tennessee 41

	Texas 42 mm            mm ••

Utah 43

	Vermont 44

	Virginia 45

	Washington 46

	West Virginia 47

	Wisconsin 48

	Wyoming 49 ___

Virgin Islands 60 mm            mm ... •• ••

Guam 61 ^M •I            I mm •i mm

 

 

	Participation Supplement

	Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 060

	r\ & r\ nr DalAttnn Q Revised Participation (or
this Une of Insurance

	BOILER & MACHINERY ^ |0|6|0| orPeletlon dd^o..^^..^

I            I            I I            I            I I            I            I           &nb
sp;Line Services Rules Forms
Effective Date            I            I            I I            I            I I            I         
;   I            j—1 i—i

	TVp«of ^ State \ Filing            V\\
\ Participation \ Services \ Authorization \\\
\ |oh^Xlp«ftl.li| \ ..... \\\

	___01 02 03 04 05 V 06 ] 07 ~ OB 09

Month            Day            Year | ............... | | ............... |
| | | | | |
Alabama 01 I            I

Alaska 54 1

Arizona 02

Arkansas 03

California 04

Colorado 05

Connecticut 06

Delaware 07

Olst. of Col. 08

Florida 09

Georgia 10

	Idaho 1 1

	Illinois 12

	Indiana 13

	Iowa 1 4 1

	Kansas 15

	Kentucky 16

	Louisiana 1 7

Maine 18

	Maryland 19

	Massachusetts 20

	Michigan 21

	Minnesota 22

	Mississippi 23

	Missouri 24

	Montana 25

	Nebraska 26 —

Nevada 27

	New Hampshire 28

	New Jersey 29 1

	New Mexico 30

	New York’ 31

	North Carolina 32

	North Dakota 33

	Ohio 34

	Oklahoma 35 1

	Oregon 36 H=

Pennsylvania 37

	Puerto Rico 58

	Rhode Island 38 |

	South Carolina 39

	South Dakota 40 1

	Tennessee 41 M M n:

	Texas 42

	Uteh 43

	Vermont 44

	Virginia 45

	Washington 48

	West Virginia 47

	Wisconsin 48 Hi •

Wyomins 49 •

Virgin Islands 50

	Guam 51

	Please complele a separate lorm lor Texas Statistical Agent Service. ‘FA lor New York rules is
applicable to classification and territories only.

	Note: In certain states, services may be limited by law.

Rating information Services correspond to loss/cost and rules services.

 

 

	Participation Supplement

Line Of Insurance            Original or Revision nominalP«rttfPa*>nlorihlsUneolInsurance
RnqrKn?qc?nWm?Rq            I Si 9 I 0|orDetetion qRevlS«JParticipaU0n.0rW< SUB style="font-size: 85%; vertical-align: text-bottom">8Uneo)Insurance
BUblJMi!ibbUWIOiK8CODE            I            I            I W I            Q Defc^n of thte Urwol Insurance

I            I            I I            I            I I            I            ILine Services Rules Forms
Effective Date            I            II I            I            I I            I            I        &nbs
p;   i—i            i—i

	Month            Day            Year            I | | ................................ |

	~S.CONT\TVp*of\State\ Filing^^\
Participation\ Services \ Authorization \\\
(cMcmpWtf.it)\ ‘\\\\

	01 02 03 04 05 OS 07 08 ................................................ 09

	Alabama 01

Alaska 54

Arizona 02

	Arkansas 03

California 04

	Colorado 05

	Connecticut 06

	Delaware 07

	Dlst. 01 Col. 08

	Florida 09

	Georgia 1 0

Hawaii 52

	Idaho 11

	Illinois 12

	Indiana 13

	Iowa 14

	Kansas 15

	Kentucky 1 8

Louisiana 17

	Maine 18

	Maryland 19

	Massachusetts 20

	Michigan 21

	Minnesota 22

	Mississippi 23

	Missouri 24

	Montana 25

	Nebraska 28

	Nevada 27

	New Hampshire 28

	New Jersey 29

	New Mexico 30

	New York’ 31

	North Carolina 32

	North Dakota 33

	Ohio 34

	Oklahoma 35

	Oregon 38

	Pennsylvania 37

	Puerto Rico 58

	Rhode Island 38

	South Carolina 39

	South Dakota 40

	Tennessee 41

	Texas 42

	Utah 43

	Vermont 44

	Virginia 45

	Washington 46

	West Virginia 47

	Wisconsin 48 till

	Wyomlnfl 49 mmM

	Virgin Islands 60

	Guam 81

 

 

	Participation Supplement

	Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 290

ILine Services Rules Forms
Effective Date

	Month            Day            Year            I | | ................. |

	~S.CONT\ Type of\ State \ Filing \
\ Participation \ Services \ Authorization
\ la»oHu.r«UI«| .. \ \ .......

	01 02 03 04 05 06 07 | OB | O9 |

Alabama 01

Alaska 54 •

Arizona 02

Arkansas 03

California 04

Colorado 05

Connecticut 06

Delaware 07

Dist. of Col. 08

Florida 09

Georgia 10

Hawaii 52

Idaho 1 1

Illinois 12

Indiana 13

Iowa 1 4

Kansas 15

Kentucky 16

Louisiana 1 7

Maine 18

Maryland 19

Massachusetts 20

Michigan 21

Minnesota 22

Mississippi 23

Missouri 24

Montana 25

Nebraska 26

Nevada 27

New Hampshire 28

New Jersey 29

New Mexico 30

New York’ 31

North Carolina 32

North Dakota 33

Ohio 34

Oklahoma 35

Oregon 36

Pennsylvania 37

Puerto Rico 58

Rhode Island 38

South Carolina 39

South Dakota 40

Tennessee 41

Texas 42

Utah 43

Vermont 44

Virginia 45

Washington 48

West Virginia 47

Wisconsin 48

	Wyoming 49

Virgin Islands 50

	Guam 61

	Note: In certain states, services may be limited by law.

	·FA for New York rules Is applicable to and territories only.

 

 

	Participation Agreement Supplement

	Line of Insurance
COMMERCIAL PACKAGE POLICY CODE 360 Original Or Revision °“Orginall
Participation lor this Line of Insurance or
Deletion            Revlsed
Participation for this Line of Insurance
Deletion of this Line of Insurance

	Effective Date            Line Services            Rules Forms

	Month            Dey            Year

	\ Participation \ State Sen/Ices \ \ Filing \ \ Authorization \ \
\ (check 1 per ) \

	01 02 03 04 05 06 07 | OB | O9 |

Alabama 01 ••••

Alaska 54 •

Arizona 02

Arkansas 03

California 04

Colorado 05

Connecticut 06

Delaware 07

Dist. of Col. 08

Florida 09

Georgia 10

Hawaii 52

Idaho 1 1

Illinois 12

Indiana 13

Iowa 1 4

Kansas 15

Kentucky 16

Louisiana 1 7

Maine 18

Maryland 19

Massachusetts 20

Michigan 21

Minnesota 22

Mississippi 23

Missouri 24

Montana 25

Nebraska 26

Nevada 27

New Hampshire 28

New Jersey 29

New Mexico 30

New York’ 31

North Carolina 32

North Dakota 33

Ohio 34

Oklahoma 35

Oregon 36

Pennsylvania 37

Puerto Rico 58

Rhode Island 38

South Carolina 39

South Dakota 40

Tennessee 41

Texas 42

Utah 43

Vermont 44

Virginia 45

Washington 48

West Virginia 47

Wisconsin 48

	Wyoming 49

Virgin Islands 50

	Guam 51

	Please complete a separate form for Texas Statistical Agent Service.

	Note: In certain states, services may be limited by law.

	·FA for New York rules is applicable to classification and territories only.

	Participation Agreement Supplement

	Line of Insurance
COMMERCIAL PACKAGE POLICY CODE 360 Original Or Revision °“Orginall
Participation lor this Line of Insurance or
Deletion            Revlsed
Participation for this Line of Insurance
Deletion of this Line of Insurance

 

 

	Participation Supplement
Original Or Revision            Original Participation
for this Line of Insurance Or Deletion
Line of Insurance            Revlsed Participation lor this Une of
CRIME & FIDELITY            CODE            Insurance O Deletion of this Line of Insurance
0 7 0

	Effective Date            Line Services            Rules Forms

	Monih            Day            Year

	articipation            State \ Filing \ \ \ Authorization \ \ \
Services
chtek 1 per
state
——  ——  —

	States A\A \for for \

	\ \
01 02 03 04 55 06 | 07 OB 09

	—   —   —   —  ——  ——   —   —  —
Alabama 01 This service
—
Alaska 54 1

	——  -

	Arizona 02 i •
—
Arkansas 03

	—
California 04

	—
Colorado 05

	—
Connecticut 08 u
m
D” S
i D
S
ye
8

	! 1
—
Delaware 07

	—
Dist. of Col. 08

	—
Florida 09

	—
Georgia 1 0
—
Idaho 1 1 4

	—
Illinois 12

	—
Indiana 13

	—
Iowa 14

	—
Kansas 1 5
—
Kentucky 16

	—
Louisiana 1 7
—
Maine 18

	—
Maryland 19

	—
Massachusetts 20

	—
Michigan 21

	—
Minnesota 22

	—
Mississippi 23

	—
Missouri 24

	—
Montana 25

	—
Nebraska 26

	—
Nevada 27

	—
New Hampshire 28

	—
New Jersey 29

	—
New Mexico 30

	—
New York” 31

	—
North Carolina 32

	—
North Dakota 33

	—
Ohio 34

	—
Oklahoma 35

	—
Oregon 36 —
—
Pennsylvania 37

	—
Puerto Rico 58

	—
Rhode Island 38

	—
South Carolina 39

	—
South Dakota 40

	—
Tennessee 41 I
—
Texas 42

	—
Utah 43

	—
Vermont 44

	—
Virginia 45

	—
Washington 46

	—
West Virginia 47

	—
Wisconsin 48

	—
Wyoming 49 • ^mm
—
Virgin Islands 50

	—
Guam 51

	—
t Please complete a separate from lor Texas Statistical Agent Service. *FA lor New York rules Is applicable to classification and territories only. Note: In certain states, services
may be limited by law. Rating Information Services correspond to loss/cost and rules services.
Rev. 1/2007

 

 

	Participation Supplement
Original or Revision O Original Participation lor this Line
of Insurance Or Deletion            n Revised
Line of Insurance            Participation for this Une ol Insurance n Deletion of this
EMPLOmiKT-RELATED PRACTICES LIABILITY            DOE            Lins of Insurance
3 g 0
 —  ——  —
Effective Date            Line Services            Rules Forms
—

	Month            Day            Year
——  —

	\ Participation \ State \ Services            Flling
(chek 1 per state) Authorization \ \ \ \
——  ——  —

	States            v\\\\
01 02 03 04 05 | 06 I 07 08 09

	—   —   —   —  ——  ——   —   —  —
Ajabama 01 1

	——  -

	Alaska 54

	—
Arizona 02 4

	—
Arkansas 03 •
—
California 04

	—
Colorado 05

	—
Connecticut 06

	—
Delaware; 07

	—
Dist. of Col. 08

	—
Florida 09

	—
Georgia 10

	—
Idaho 11 i 4

	—
Illinois 12

	—
Indiana 13

	—
Iowa 14

	—
Kansas 15

	—
Kentucky 18

	—
Louisiana 17

	—
Maine 18

	—
Maryland 19

	—
Massachusetts 20

	—
Michigan 21

	—
Minnesota 22

	—
Mississippi 23

	—
Missouri 24

	—
Montana 25

	—
Nebraska 26 -=
—
Nevada 27

	—
New Hampshire 28

	—
New Jersey 29

	—
New Mexico 30

	—
New York* 31

	—
North Caollna 32

	—
North Dakota 33

	—
Ohio 34

	—
Oklahoma 35

	—
Dragon 36

	—
Pennsylvania 37

	—
Puerto Rico 58

	—
Rhode Island 38

	—
South Carolina 39

	—
South Dakota 40

	—
Tennessee 41 I            Mi ^
—
Texas 42

	—
Utah 43

	—
Vermont 44

	—
Virginia 45

	—
Washington 46

	—
West Virginia 47

	—
Wisconsin 48

	—
Wyoming 49

	—
Virgin Islands 50

	—
Guam 51

	—

 

 

	Participation Supplement
—
Original or Revision D Original Participation for this Line of
Insurance Or Deletion ^ Revvisedl
Line of Insurance            Participation lor this Line of Insurance O Deletion of this Line of
FARM            noriF            Insurance
0 8 0
 —  ——  —
Effective Date            Line Services            Rules Forms
—

	Worth            Day            Year
——  —

	Participation            State \ Services            Filing \ \ \ Authorization \ \ \
\ (check 1 per stae)
——  ——  —

	States            A \\\\\
 —  —
01 02 03 04 05 | OS            I 07 08 09 Rev. 1/2005
 —   —   —  ——  ——  ——   —  ——  —
Alabama 01

	—
Alaska 54

	—
Arizona 03 i •
—
Arkansas 03

	—
California 04

	—
Colorado            OS
—
Connecticut 08

	—
Delaware 07

	—
Florida 09

	—
Georgia 10

	—
Idaho 1 1 4
—
Illinois 12

	—
Indiana 13

	—
Iowa 14

	—
Kansas 15

	—
Kentucky 16

	—
Louisiana 17

	—
Maine 18

	—
Maryiand 19

	—
Massachusetts 20

	—
Michigan 21

	—
Minnesota 22

	—
Mississippi 23

	—
Missouri 24

	—
Montana 25

	—
Nebraska 26

	—
Nevada 27

	—
New Hampshire 28

	—
New Jersey 29

	—
New Mexico 30

	—
New York” 31

	—
North Carolina 32

	—
North Dakota 33

	—
Ohio 34

	—
Oklahoma 35

	—
Oregon 38

	—
Pennsylvania 37

	—
Puerto Rico 58

	—
Rhode Island 38

	—
South Carolina 39

	—
South Dakota 40

	—
Tennessee 41 - HZ
—
Texas 42

	—
Utah 43

	—
Vermont 44 I            I
——  —

	Virginia 45

	—
Washington 46

	—
West Virginia 47  —  I            i
——   —  —

	Wisconsin 48 m •
—
Wyomina 49 •
—
Virgin Islands 50

	—
Guam 51 I
—
Note: In certain states, services may be limited by law. Rating Information Services correspond to loss/cost and rules services. *FA for New York rules is applicable to classification and territories only.

 

 

	Participation Supplement
—
Original or Revision Q Ori9inal
participation for this Line of Insurance Or Deletion
Line of Insurance            Revised Participation for this Line of Insurance O
GENERAL LIABILITY 0 ODE            Delation ol this Une ol Insurance
1 0 0
——  —
Effective Date            Line Services            Rules Forms
—

	Month            Day            Year
—
\ Participation \
(check 1 per state) V State \ Filing \ \ \ Services            Authorization \ \ \
——  —

	Stales \
A
—
01 02 03 04 06 | 06 07 OB 09

	——  ——  ——   —  ——   —   —   —  —
D 1
en ES’
D
ffl
§
fi>
1 &
o 1
8 s 8 |
Alabama 01 I            I
——  -

	Alaska 54

	—
Arizona 02 • I
—
Arkansas 03

	—
California 04

	—
Colorado 05

	—
Connecticut 06

	—
Delaware 07

	—
Dist. of Col. 08

	—
Florida 09

	—
Georgia 10 = =
—
Hawaii 52

	—
Idaho 11

	—
Illinois 12

	—
Indiana 13

	—
Iowa 14

	—
Kansas 15

	—
Kentucky 16

	—
Louisiana 1 7
—
Maine 18

	—
Maryland 19

	—
Massachusetts 20

	—
Michigan 21

	—
Minnesota 22

	—
Mississippi 23

	—
Missouri 24

	—
Montana 25

	—
Nebraska 26

	—
Nevada 27

	—
New Hampshire 28

	—
New Jersey 29 I
——  -

	New Mexico 30 | |
——  —

	New York* 31

	—
North Carolina 32

	—
North Dakota 33

	—
Ohio 34

	—
Oklahoma 35

	—
Oregon 36

	—
Pennsylvania 37

	—
Puerto Rico 58

	—
Rhode Island 38

	—
South Carolina 39

	—
South Dakota 40

	—
Tennessee 41

	—
Texas 42

	—
Utah 43

	—
Vermont 44

	—
Virginia 45

	—
Washington 48

	—
West Virginia 47

	—
Wisconsin 48

	—
Wyoming 49

	—
Virgin Islands 50

	—
Guam 51

	—
Please complete a separate form for Texas Statistical Agent Service. ‘FA (or New York rules Is applicable to classification and territories only. Note: In certain states, services may be limited by law. Rating Information Services correspond to loss/cost and rules services.
Rev. 1/2007

 

 

	Participation Supplement }
—

	Line of Insurance            Original or Revision D °"<*ml p«rtlc|pa*” *» ins ur
» of insurance
GLASS            Or Deletion ^ Revised Participation for this Line of Insurance D Deletion of this Line of Insurance
cooe            GLUE
—

	Line Services            Rules Forms
Effective Date            D            D

-
Month            Day            Year
—
k            Rev.

	Participation \ foteek 1 Stalo \ Filing ‘ \ \\\
ptr *Mo) \ Services \ Authorization
——  ——  —

	\\\ \\\\\ \
w \WA
s*»t»« V            A. MvA\V            A\\\\\\
——  ——  —

	1 01 I 02 \ 03 [ 04 J            W. } 09 07 1 08 1 08 | 11
1 10
——  ——  —

	Alabama 01 I            I
——  -

	Alaska 54

	—
Arizona 02 • I
—
Arkansas 03

	—
California 04

	—
Colorado 05

	—
Connecticut 06

	—
Delaware 07

	—
Dist. of Col. 08

	—
Florida 09

	—
Georgia 10 = =
—
Hawaii 52

	—
Idaho 11

	—
Illinois 12

	—
Indiana 13

	—
Iowa 14

	—
Kansas 15

	—
Kentucky 16

	—
Louisiana 1 7
—
Maine 18

	—
Maryland 19

	—
Massachusetts 20

	—
Michigan 21

	—
Minnesota 22

	—
Mississippi 23

	—
Missouri 24

	—
Montana 25

	—
Nebraska 26

	—
Nevada 27

	—
New Hampshire 28

	—
New Jersey 29 I
——  -

	New Mexico 30 | |
——  —

	New York* 31

	—
North Carolina 32

	—
North Dakota 33

	—
Ohio 34

	—
Oklahoma 35

	—
Oregon 36

	—
Pennsylvania 37

	—
Puerto Rico 58

	—
Rhode Island 38

	—
South Carolina 39

	—
South Dakota 40

	—
Tennessee 41

	—
Texas 42

	—
Utah 43

	—
Vermont 44

	—
Virginia 45

	—
Washington 48

	—
West Virginia 47

	—
Wisconsin 48

	—
Wyoming 49

	—
Virgin Islands 50

	—
Guam 51

	—
t Please complete a separate form for Texas Statistical Agent Service. Note: In certain states, services may be limited by law.

 

 

	Participation Supplement
—

	Participation for this Una of Insurance Or Deletion
^ Revlsed Participation for this Una of
Line of Insurance COMMERCIAL INLAUD MARINE ^ Insurance D Deletion of this Line of Insurance
1 2 0

	-  —  —
Effective Date            Line Services            Rules Forms
n            n
—
Month            Day            Year
——  —

	lypeof \ Participation            State \ Services \ Filing \ V \ Aulhorlzatlon \ \ \
\ lohtcklpirilllo) ‘
——  ——  —

	States \ \ V \\v            v \\ •* ‘
\\\ £ \\v \\ Yw\ \\\\\\\\\
-—   —  -—   —  —
01 02 03 04 05 | 06 | 07 08 09

	—   —   —   —  ——  ——   —   —  —
n i
a %
tt
n o
I s
I
a ff
!
Alabama 01 I            I
——  -

	Alaska 54

	—
Arizona 02 • I
—
Arkansas 03

	—
California 04

	—
Colorado 05

	—
Connecticut 06

	—
Delaware 07

	—
Dist. of Col. 08

	—
Florida 09

	—
Georgia 10 = =
—
Hawaii 52

	—
Idaho 11

	—
Illinois 12

	—
Indiana 13

	—
Iowa 14

	—
Kansas 15

	—
Kentucky 16

	—
Louisiana 1 7
—
Maine 18

	—
Maryland 19

	—
Massachusetts 20

	—
Michigan 21

	—
Minnesota 22

	—
Mississippi 23

	—
Missouri 24

	—
Montana 25

	—
Nebraska 26

	—
Nevada 27

	—
New Hampshire 28

	—
New Jersey 29 I
——  -

	New Mexico 30 | |
——  —

	New York* 31

	—
North Carolina 32

	—
North Dakota 33

	—
Ohio 34

	—
Oklahoma 35

	—
Oregon 36

	—
Pennsylvania 37

	—
Puerto Rico 58

	—
Rhode Island 38

	—
South Carolina 39

	—
South Dakota 40

	—
Tennessee 41

	—
Texas 42

	—
Utah 43

	—
Vermont 44

	—
Virginia 45

	—
Washington 48

	—
West Virginia 47

	—
Wisconsin 48

	—
Wyoming 49

	—
Virgin Islands 50

	—
Guam 51

	—
t Please complete a separate form for Texas Statistical Agent Service. ‘FA for New York rules Is applicable to classification and territories only. Note: In certain states, services may be limited by law. Rating Information Services correspond to
and rules services. R9V. 1/2005

 

 

	Participation Supplement
—

	| | | | | | | | | | | | | |
Original or Revision D °"9lnal fortdpo*1” “» »i» uhb of insurance
Line of Insurance            QP Deletion ^ Revised Participation for this Line of Insurance D Deletion of this Una of
MANAGEMENT PROTECTION PROGRAM            ra 3DE            Insurance
3 5 0

	- ——  —
Effective Date            Line Services            Rules Forms
Month            Day            Year
——  —

	\ Type of \ \ Participation \ State \ Services \ Filing \ \ \ Authorization \ \ \
\ lotKok 1 per itatt) ]
——  ——  —

	^
\y\y \ A •* ‘ vw\
States \ * \ * V \ A \%« \V\\\\\\\
 —  ——  ——  —
_25___L_£2_|
01 02 03 04 05 | OB            j 07 1

	—   —   —   —  ——  ——  —
Alabama 01 1 1

	——  —

	Alaska 54 i
—
Arizona 02

	—
Arkansas 03

	—
California 04

	—
Colorado 05

	—
Connecticut 06

	—
Delaware 07

	—
Dist. of Col. 06

	—
Florida 09

	—
TM
Georgia 10 = ? I
—
Hawaii 52

	—
Idaho 11

	—
Illinois 12

	—
Indiana 13

	—
Iowa 14 ___r            i
——  —

	Kansas 15

	—
Kentucky 16

	—
Louisiana 17

	—
Maine 18

	—
Maryland 19 =•
—
Massachusetts 20

	—
Michigan 21 ^B
——  —

	Minnesota 22 ^B
——  —

	Mississippi 23 ^B
——  —

	Missouri 24 ^B
——  —

	Montana 25 ^B
——  —

	Nebraska 26 =•  — = u
—
Nevada 27

	—
New Hampshire 26

	—
New Jersey 29 i            i ^B
——  ——  —

	New Mexico 30 Et            H
—
New York 31

	—
North Carolina 32

	—
North Dakota 33 i            i ^H
——  ——  —

	Ohio 34 ^B
——  —

	Oklahoma 35 ^B
——  —

	Oregon 36 ^|
——  —

	Pennsylvania 37 ^B
——  —

	Puerto Rico 56 ^B
——  —

	Rhode Island 36 ^B
——  —

	South Carolina 39 ^B
——  —

	South Dakota 40 ^B
——  —

	Tennessee 41 •i 1^ 4

	—
Texas 42

	—
Utah 43

	—
Vermont 44 ^B
——  —

	Virginia 45 ^B
——  —

	Washington 46 ^B
——  —

	West Virginia 47 ^B
——  —

	I
Wisconsin 48 El • l • Rev. 1/2005
—
Wyoming 49
—
Virgin Islands 50

	—
Guam 51

	—
t Please complete a separate form for Texas Statistical Agent Service. Note: In certain states, services may be limited by law.

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 380 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 150 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 370 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 340 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 330 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 090 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 020 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

	Participation Supplement
Line Of Insurance            Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 030 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month            Day            Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member            Subcriber            Service Purchaser            Loss Costs Rules            forms            Rules            forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 45
Washington 46
West Virginia 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51

 

 

     

	Participation Agreement Supplement Line Of Insurance Original Participation for this Line of Insurance
Revised Participation for this Line of Insurance Deletion of this Line of Insurance PERSONAL INLAND MARINE
CODE 040 or Deletion Line Services Rules Forms Effective Date Month Day Year Type of Participation
check 1 per state) State Services Filing Authorization Rating Information States Member Subscriber
Service Purchaser Service Forms Rulles Forms Statistioal Agent Service Actuarial Service 01 02 03 04 05 06 07 08 09
Alaska 54 Arizona 02 This Arkansas 03 Connecticut 06 Delaware 07 Dlst. of Col. 08 Florida 09 2 Georgia 10
Hawaii 52 Kansas 15 Kentucky 16 3. Louisiana 17 Maine 18 Maryland 19 Massachusetts 20 Michigan 21 *
Minnesota 22 Missouri 24 Montana 25 Nebraska 26 Nevada 27 New Hampshire 28 New Jersey 29 New Mexico 30 New York 31
North Carolina 32 North Dakota 33 Ohio 34 Oklahoma 35 Oregon 36 Pennsylvania 37 Puerto Rico 58 Rhode Island 38
South Carolina 39 South Dakota 4D Tennessee 41 Texas 42 Utah 43 Vermont 44 Virginia 45 Washington 46 West Virginia 47
Wisconsin 48 Wyoming 49 Virgin Islands 60 Guam 61 Note: In certain states, services may be limited by law.
Rating Information Services correspond to loss/cost and rules services. Rev. 4/2003

 

 

     

	Participation Supplement Line of Insurance PERSONAL LIABILITY code 045 Original or
Revision or Deletion Original Participation for this Line of Insurance Revised Participation
for this Line of Insurance Deletion of this Line of Insurance Effective Date Month Day Year
Line Services Rules Forms State Services Filing .Authorization Participation check 1 per state)
Rating Information
 States Member Subscriber Service Purchaser Service Forms Rulles Forms Statistioal
Agent Service Actuarial Service 01 02 03 04 05 O6 07 08 Alabama D1 Alaska 54 I Arizona D2 Arkansas 03
California 04 Colorado OS Connecticut 06 Delaware 07 Dlst. of Col. 08 Florida 09 Georgia 10 Hawaii 52 Idaho 11
Illinois 12 Indiana 13 Iowa 14 Kansas 15 Kentucky 16 Louisiana 17 Maine 18 Maryland 19 Massachusetts 20 Michigan 21
Minnesota 22 Mississippi 23 Missouri 24 Montana 25 Nebraska 26 Nevada 27 New Hampshire 28 New Jersey 29
New Mexico 30 New York 31 North Carolina 32 North Dakota 33 Ohio 34 Oklahoma 35 Oregon 36
Pennsylvania 37 Puerto Rico 58 Rhode Island 38 South Carolina 39 South Dakota 40 Tennessee 41 Texas 42 Utah 43
Vermont 44 Virginia 45 Washington 46 West Virginia 47 Wisconsin 48 Wyoming 49 Vlrgin Islands 60 Guam 61
Note: In certain states, services may be limited by law. Rating Information Services correspond to loss/cost
and rules services. FA for New York rules is applicable to classification and territories only. Rev. 1/2005

 

 

     

	Participation Supplement—Instructions General Instructions Please complete a separate Participation
Agreement Supplement for each line of insurance for which you need our services.
Lines of Insurance The lines of Insurance serviced by ISO are: Personal Lines Commercial Lines
Personal Automobile Commercial Automobile (Liability and Physical Damage) · Boiler & Machinery ·
Dwelling Property Crime & Fidelity Homeowners E-commerce Personal Inland Marine Farm Personal Liability
Financial Institutions Commercial Property General Liability Glass Commercial Inland Marine Commercial Package Policy
· Professional Liability Businessowners · Employment-Related Practices Liability · Market Segments
· Commercial Umbrella · Capital Assets (Output Policy) · Management Protection Program
Note: Basic Service is automatically provided to all companies participating for any Line Service
or Actuarial Service. Effective Date The effective date should be a current or prospective date.
Please use two- digit numerical entries for month/day/year. Format On the front of the Participation
Agreement Supplement, please select: · the effective date of this participation; · the type of participation
you want; · the specific services you want. On the back of the Participation Agreement Supplement, please:
· identify your company/group; · have an authorized official of your company sign the form. .
How to Indicate Changes If this is an original submission for this line of insurance, the form
you submit to us should fully represent your entire desired participation at the date of signing.
When you wish to revise an existing participation, indicate on the Participation Agreement Supplement
only those items that are to be changed. If you are expanding your participation, place an (x) in the
appropriate box(es). Place an (o) in the appropriate box(es) to delete any participation service.
A check in the Deletion box will delete your participation for the entire line of insurance.
Type of Service Please indicate the specific services you want by indicating an (x) in the
appropriate boxes. The following guide may be helpful in identifying which services and products
are available for each participation. Line Service — Rules —This service entitles your company to
receive our multistate rules information distributed by circular and by manual. Over Rev. 1/2005

 

 

     

	Participation Supplement—instructions (cont’d) Type of Service . Line Service — Forms
—This service entitles your company to receive our multistate forms information distributed by
circular and by forms portfolio manual. • State Service — Rating Information Services This service
entitles your company to receive our advisory loss costs and rules information for the specific state(s) selected.
A company must also be participating for Line Service — Rules and State Service — Rules in order to obtain
this service. — Forms This service entitles your company to receive our forms information for the specific
state(s) selected. A company must also be participating for Line Service — Forms in order to obtain this service.
Filing Authorization This service authorizes ISO to file its Rules and/or Forms on your behalf and is available
only to those Member and Subscriber companies also participating for the corresponding State Services. In addition
to completing the appropriate columns on this Participation Agreement Supplement, please complete a Filing
Authorization Form. Central Distribution — Forms Central Distribution — Forms entitles companies to order
multiple copies of ISO’s forms and endorsements. Statistical Agent Service This service authorizes ISO to act
as your company’s statistical agent. ISO’s Statistical Division will contact you with pertinent instructions
and eligibility requirements for the various types of statistical plans, and will assist you in selecting the
most practical plan available to suit your needs. Actuarial Service For all lines of insurance, you must also
participate for Line Service — Rules in order to obtain Actuarial Service. The Actuarial Service participation
is a single countrywide participation per line, although both countrywide and state information is supplied.
Check the box at the top of the appropriate column to participate for this service.
Manuals and Circulars Please complete and return the appropriate order forms in order to receive ISO’s
manual and circular services. Please feel free to contact ISO Customer Service at 1-800-888-4476 option 2
if you require assistance in ordering any of our products. Return Address Please return your completed
Participation Agreement Supplements to: ISO Customer Service 545 Washington Boulevard Jersey City, NJ 07310-1686
Questions If you have any questions about the completion of these forms, or about your company’s ISO participation,
please feel free to contact Customer Service at 1-800-888-4476, Option 2 or Fax: (201) 748-1472. Rev. 11/2004

 

 

     

	INSURANCE SERVICES OFFICE, INC. Participation Supplement—Texas: Instructions General Instructions
Please complete this supplement for all companies writing business in Texas. If you have not already done
so, you must also execute the ISO Master Agreement. How to Complete This Form 1. On the first page of the
Participation Supplement Texas, please identify your company name, NAIC company number and NAIC group number,
and company IRD #. 2. For each line of insurance for which you write business in Texas, please select the
reporting option you want as indicated in the
 appropriate sections. 3. On the back page of the Participation
Supplement Texas, please have an authorized official of your company sign the form, and complete
 remaining
information on the back page. 4. One supplement can be used for several companies ONLY if the information is
identical for all companies listed. All companies for which participation information applies should be listed
on the back page. Separate supplement forms are needed for each company with unique statistical reporting
information. How to Indicate Changes If this is an original submission, the form you submit should fully
represent your reporting options for all commercial lines you write in Texas. If you need to make a revision
to any selection, expand into new lines of insurance, or delete a prior selection (if you no longer write that
type of insurance), place an (x) in the appropriate box(es). A check mark in the Delete box indicates your
company no longer writes that line of insurance. In all cases, the deletion of a line of insurance requires
an exemption from the Texas Department of Insurance (TDI). To add or delete a company from your group, please
indicate on the back page. Statistical Reporting Date This date should identify the earliest quarter/year
when data will be submitted to ISO. Return Address Please return your completed Participation Supplement Texas to:
Insurance Services Office, Inc. Customer Service Division 545 Washington Boulevard Jersey City, NJ 07310-1686
Questions If you have any questions about the completion of this form, please feel free to contact our Customer
Service Division at (800) 888-4476 opt. 2. Fax: (201)748-1472.

 

 

	INSURANCE SERVICES OFFICE, INC.

	Participation Supplement—Texas
TEXAS COMMERCIAL LINES STATISTICAL AGENT SERVICE Service
Purchaser Participation
Name of Group/Co.: NAIC Group#: Original or Revision            Original Participation
NAIC Company *: ...................... Revised Participation IRD#:

	Insurers may report under the format of ISO’s amended Commercial Statistical Plan for
Texas (CSP Plus) or the format of the Texas Commercial Lines Statistical Plan
(TCLSP). For Liability, Property, Businessowners, Commercial Automobile and
Miscellaneous Commercial, data reported under CSP Plus may be utilized in ISO loss
cost development at each insurer’s option. If you give ISO permission to utilize the
data you report under CSP Plus in our loss cost development, the ISO statistical
reporting credit program will be applicable to the data. Data reported under TCLSP is
not utilized in ISO loss cost development and therefore is not eligible for a
statistical reporting credit.

	Please indicate the line categories for which you will report Texas commercial
statistical data, and whether the data can be utilized in ISO loss cost development,
by checking all appropriate boxes:

	LINES OF INSURANCE
LIABILITY
General Liability            code 100

	Data will be reported in CSP Plus format. Data may be utilized in ISO
loss cost development (data is eligible for the ISO statistical
reporting credit program).

	Add/New Delete Change format

	Data will be reported in CSP Plus format. Data may not be utilized in
ISO loss cost development (data is not eligible for the ISO statistical
reporting credit program).

	Add/New Delete Change format

	Data will be reported in TCLSP format. Data reported in this format is
not utilized in ISO loss cost development (data is not eligible for the
ISO statistical reporting credit program).

	Add/New            Delete Change format

	Vendor (if applicable): (e.g., TICO)

 

 

	Medical Professional Liability code 150

	Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program).

	Add/New Delete Change format

	Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical
reporting credit program).

	Add/New Delete Change format

	Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program).

	Add/New            Delete            Change format
Vendor (if applicable): (e.g., TICO)
COMMERCIAL PROPERTY            code 090

	Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program).

	Add/New Delete Change format

	Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical reporting
credit program).

	Add/New Delete Change format

	Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program).

	Add/New            Delete Change format

	Vendor (if applicable):(e:g., TICO)

 

 

	BUSINESSOWNERS code 130

	Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program).

	Add/New Delete Change format

	Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical
reporting credit program).

	Add/New Delete Change format

	Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program).

	Add/New            Delete            Change format
Vendor (if applicable): (e.g.,TICO)
COMMERCIAL AUTOMOBILE            code 050

	Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program).

	Add/New Delete Change format

	Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical reporting
credit program).

	Add/New Delete Change format

	Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program).

	Add/New            Delete Change format

	Vendor (if applicable):(e.g., TICO)

 

 

	MISCELLANEOUSCOMMERCIALBoiler&Machinerycode060DatawillbereportedinCSPPlusformat.DatamaybeutilizedinI
SOlosscostdevelopment(dataiseligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangef
ormatDatawillbereportedinCSPPlusformat.DatamaynotbeutilizedinISOlosscostdevelopment(dataisnoteligibl
efortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatDatawillbereportedinTCLSPforma
t.DatareportedinthisformatisnotutilizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatistica
lreportingcreditprogram).Add/NewDeleteChangeformatVendor(ifapplicable):(e.g.,TICO)BurglaryandTheftco
de070DatawillbereportedinCSPPlusformat.DatamaybeutilizedinISOlosscostdevelopment(dataiseligibleforth
eISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatDatawillbereportedinCSPPlusformat.Da
tamaynotbeutilizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogr
am).Add/NewDeleteChangeformatDatawillbereportedinTCLSPformat.Datareportedinthisformatisnotutilizedin
ISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteCha
ngeformatVendor(ifapplicable):(e.g.,TICO)

 

 

	Glasscode110DatawillbereportedinCSPPlusformat.DatamaybeutilizedinISOlosscostdevelopment(dataiseligib
lefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatDatawillbereportedinCSPPlusfo
rmat.DatamaynotbeutilizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcred
itprogram).Add/NewDeleteChangeformatDatawillbereportedinTCLSPformat.Datareportedinthisformatisnotuti
lizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDe
leteChangeformatVendor(ifapplicable):(e.g.,TICO)CommercialInlandMarinecode120DatawillbereportedinCSP
Plusformat.DatamaybeutilizedinISOlosscostdevelopment(dataiseligiblefortheISOstatisticalreportingcred
itprogram).Add/NewDeleteChangeformatDatawillbereportedinCSPPlusformat.DatamaynotbeutilizedinISOlossc
ostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeforma
tDatawillbereportedinTCLSPformat.DatareportedinthisformatisnotutilizedinISOlosscostdevelopment(datai
snoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatVendor(ifapplicable
):(e.g.,TICO)

 

 

	FIDELITY&SURETYcode310MonolinePackageDatawillbereportedinCSPPlusformat.Add/NewDeleteChangeformatData
willbereportedinTCLSPformat,Add/NewDeleteChangeformatVendor(ifapplicable):(e.g.,TICO)MISCELLANEOUSPE
RSONALcode200PersonalTheftPersonalInlandMarinePersonalGlassPersonalLiabilityDatareportedunderthemisc
ellaneouspersonalcoverageslinecategoryisforTexasCommercialLinesStatisticalAgentServicerequirementson
ly.CompaniesparticipatingforISOpersonallinesdatareportingmustcontinuetoalsoreportthisdataundertheapp
licableISOstatisticalplanandreportingrequirements.DatawillbereportedinCSPPlusformat.Add/NewDeleteCha
ngeformatDatawillbereportedinTCLSPformat.Add/NewDeleteChangeformatVendor(ifapplicable):(e.g.,TICO)

 

	ParticipationSupplement-Texas(cont’d)AgreementThisparticipant,asaServicePurchaserofInsuranceServices
Office,Inc.,agreestoabidebytheprovisionsoftheParticipationSupplementexecutedbytheparticipant.Authori
zedOfficialSignatureNameTitleStatisticalReportingDate(earliestquarter/yearwhendatawillbesubmitted)Gr
oupName(ifapplicable)andNAICGroupNumberIfchanginggroups,indicateoldNAICGroup#:andthennewNAICGroup#:C
ompanyNameNAICCo.#AddDeleteCompany(ies)forwhichallparticipationinformationonthisformappliesandforwhi
chsignerisauthorizedtoactSeparateSupplementalFormsareneededforeachcompanywithuniquestatisticalreport
inginformation.CheckAddorDeleteboxifadding/deletingcompanyfromgroupentirely.HomeOfficeAddressStatist
icalContactStreetAddress/P.O.BoxCity/State/ZipTelephoneNo.TelephoneNo.FaxNo.FaxNo.E-mailE-mailDateFo
rmCompletedReturntoInsuranceServicesOffice,Inc.CustomerServiceDivision545WashingtonBoulevardJerseyCi
ty,NJ07310-1686

 

	PARTICIPATIONSUPPLEMENTDescription:Thisparticipant,asaMember,Subscriber,orServicePurchaserofInsuranc
eServicesOffice,Inc..agreestoabidebytheprovisionsoftheMasterAgreementexecutedbytheparticipant.Delive
ry:StandardISOnetInternetdelivery.Apasswordisrequired.Eachsign-onandpasswordmaybeusedonlybyoneauthor
izedindividual.ISOwillestablishaccessbasedonyourcompany’slevelofParticipation.Aregistrationkey,withu
nlimitedseats,willbeprovidedsoyoucanaccessthefollowingproductsviaISOnet:CommercialLinesManual(includ
ingMotorCarrierDigest)PersonalLinesManual(includingtheMicrosoftWorddownload)CircularsFormsFIRSTLegis
lativeMonitoringMulti-LineClassTableParticipationPlusCustomer.(ElectronicDeliveryFeeandTermDoNotAppl
y)ElectronicDeliveryFee:%(plusapplicabletaxes)Term:GroupName(ifapplicable):Company(ies)forwhichallpa
rticipationinformationonthisformappliesandforwhichsignerisauthorizedtoact:HomeOfficeAddress:StreetAd
dress/P.O.BoxCity/State/ZIPSignature:PrintName:NameofRegKeyCoordinator:Title:Title:Email:Email:Phone
Number:PhoneNumber:Date:Revised

 

 

	PARTICIPATIONSUPPLEMENTFORCHANGESTOPARTICIPATIONDescription:Thisparticipant,asaMember.Subscriber,orS
ervicePurchaserofInsuranceServicesOffice,Inc.,agreestoabidebytheprovisionsoftheMasterAgreementexecut
edbytheparticipant.GroupName(ifapplicable):Company(ies)forwhichallparticipationinformationonthisform
appliesandforwhichsignerisauthorizedtoact:HomeOfficeAddress:StreetAddress/P.O.BoxCity/State/ZIPSigna
ture:PrintName:Title:Email:PhoneNumber:Date:Revised

 

 

	FilingAuthorizationFormDonotsandthislettertotheNewYorkStateInsuranceDepartmentPleasesenditto:ISOCust
omerService545WashingtonBoulevardJerseyCity.NJ07310-1685TotheCommissionerofInsurance:Youareherebyaut
horizedtoacceptasfledonbehalfoftheundersignedMEMBERorSUBSCRIBERofINSURANCESERVICESOFFICE,INC..suchma
terialspecifiedonthisformrelatedtoClassifications,Rules,RatingPlansandRules,PolicyFormsandEndorsemen
tsandanyinformationpertainingthereto,whicharefiledInyourofficebyInsuranceServicesOffice,Inc.withresp
ecttooneormorekindsofinsurance,subdivisionsandkindsofInsuranceorclassesofrisks,oranypartofcombinatio
nofthaforegoingforwhichtheundersignedIsnoworhereafterlicensedlotransactbusiness.ThisRingAuthorizatio
nshallbedeemedamendedtotheextentthatanyrangIsmadeInyourofficedirectlybytheunder—signedcompanyandisin
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tioncurrentlyinyourofficeonbehalfoftheundersignedcompanyandmayberevokedoramendedatanytimebysuchactio
nasspecificallysetforthorbynotificationtoyourofficebytheunder—signedcompanyorbyInsuranceServicesOffi
ce,Inc.SignatureorOfficialTypedNameandTitleofOfficialNameatCompanyHomeOfficeStreetAddressCityStateZi
pRev.10/2004FilingAuthorizationForm—InstructionsGeneralIfyourcompanyisparticipatinginISOasaMemberor
SubscriberforoneormoreSlateServicesandyouwishtograntISOfilingauthorization,thisformmustbecompletedfo
rallapplicablejurisdictions.Pleasecomplete:theflingauthorizationcolumnsoftheParticipationAgreementSu
pplement,andthisFilingAuthorizationFormLimitationsNewYorkIfyouIntendtoauthorizeISOtomatefilingsonyou
rbehalfIntheStaleofNewYork,youmustcompletetheFilingAuthorizationFormfromtheStaleofNewYorkGeneralISOc
annotfileonyourbehalfincertainjunsdictionsforcertainlinesofinsurance.ThesejurisdictionsandlinesofIns
uranceareHackedoutonthechartInsidethisform.Foradditionallimitations,seetheParticipationAgreementSupp
lementforeachlineofInsurance.FormatOnthispagearegeneralInstructionsconcerningtheFilingAuthorizationF
orm.Onthecenterpagesare:asectionforyoutoindicatetheeffectivedateofthisform;acharttoidentifywhatlines
youauthorizeustofileonyourbehallandinwhatstales:andasectionforyoutoIndicateanyexceptionstothisauthor
ization.RevisionsOncethefilingauthorizationhasbeenestablished,youmaymakeanysubsequentchangestofiling
authorizationforalineofInsuranceandstatebysendingISOaFilingAuthorizationChangeLetter.ReturntoDONOTSE
NDTHISFORMTOANYINSURANCEDEPARTMENT!PleasesendthiscompteledFilingAuthorizationFormto:ISOCustomerServi
ce545WashingtonBoulevardJerseyCity,NewJersey07310-1686ISOwillmaintaintheoriginalFilingAuthorizationF
orminitsfiles.Aphotocopyoftheformwillbesenttotheappropriateinsurancedepartment(
s).Over

 

 

	FilingAuthorizationFormEffectiveDalePleaseIndicatethedatayouwishthisfilingAuthorizationtobeeffective
Thisdateshouldbecurrentorprospective.AuthorizationCodesInsertthecodesfistedbelowIntheappropriateboxo
fthechart,i.e.,byState,andTypesorKindsofInsurance:2.Rules6.Rules,Forms4.FormsExceptions.Exceptionsfo
rRingAuthorizationshouldbeIndicatedInthespaceprovidedbelow.Indicatetheline,thanthestate.Ifappropriat
e,followedbyadescriptionoftheexception(e.g..“ProfessionalLiability—allstates—wewillliteourownlawye
r’sprofessionalliabilityrulesandforms”).EffectiveDateForISOUseOnlyAlabamaAlaskaDelawareDist.ofColumb
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ooregonPenesyeviautahVermontVirginiaWashingtonWestvirginiawisconsinThesenotesapplyunlesslimitedbyane
xceptiontoStagauthority:HomeownorsincludesMobHehome:FarmInsuranceIncludesFarmCombinationCoverage.For
mProperly,Farmliability,andFarmIntendMarina:andCommercialMultipleLineincludestheCommercialPackagePol
icyProgramandtheBusinessownersProgram.EX-10.1

Exhibit 10.1

EMPLOYMENT AGREEMENT

     THIS AGREEMENT is made on the 3rd day of October, 2008 by and between Kevin Wilson (the
“Employee”) and TEAMSTAFF, INC., a New Jersey corporation (the “Company”) and is effective as of
the 1st day of October, 2008.

WITNESSETH:

     WHEREAS, the Company and its subsidiaries are engaged in the business of providing staffing
services; and

     WHEREAS, the Employee is currently employed by the Company and the Company desires to continue
the employment of the Employee and secure for the Company the experience, ability and services of
the Employee; and

     WHEREAS, the Employee desires to continue his employment with the Company, pursuant to the
terms and conditions herein set forth, superseding all prior oral and written employment
agreements, and term sheets and letters between the Company, its subsidiaries and/or predecessors
and Employee;

     NOW, THEREFORE, it is mutually agreed by and between the parties hereto as follows:

ARTICLE 1

DEFINITIONS

     1.1 Accrued Compensation. Accrued Compensation shall mean an amount which
shall include all amounts earned or accrued through the “Termination Date” (as defined below) but
not paid as of the Termination Date, including (i) Base Salary, (ii) reimbursement for business
expenses incurred by the Employee on behalf of the Company, pursuant to the Company’s

 

 

expense reimbursement policy in effect at such time, (iii) vacation pay, and (iv) unpaid
bonuses and incentive compensation earned and awarded prior to the Termination Date.

     1.2 Cause. Cause shall mean: (i) willful disobedience by the Employee of a material and lawful
instruction of the Chief Executive Officer or the Board of Directors of the Company; (ii) formal
charge, indictment or conviction of the Employee of any misdemeanor involving fraud or embezzlement
or similar crime, or any felony; (iii) conduct amounting to fraud, dishonesty, gross negligence,
willful misconduct or recurring insubordination; or (iv) excessive absences from work, other than
for illness or Disability; provided that the Company shall not have the right to terminate the
employment of Employee pursuant to the foregoing clauses (i), (iii), and (iv) above unless written
notice specifying such breach shall have been given to the Employee and, in the case of breach
which is capable of being cured, the Employee shall have failed to cure such breach within thirty
(30) days after his receipt of such notice.

     1.3 Change in Control. “Change in Control” shall mean any of the following events:

          (a) An acquisition (other than directly from the Company) of any voting securities of the
Company (the “Voting Securities”) by any “Person” (as the term person is used for purposes of
Section 13(d) or 14(d) of the Securities Exchange Act of 1934, as amended (the “1934 Act”))
immediately after which such Person has “Beneficial Ownership” (within the meaning of Rule 13d-3
promulgated under the 1934 Act) of twenty percent (20%) or more of the combined voting power of the
Company’s then outstanding Voting Securities; provided, however, that “Person,” as used in this
subparagraph 1.3(a), shall not include any Person who is the Beneficial Owner of 10% or more of the
combined voting power of the Company’s outstanding Voting Securities on the date hereof; and
provided further that in determining whether a Change

2

 

in Control has occurred, Voting Securities which are acquired in a “Non-Control Acquisition”
(as defined below) shall not constitute an acquisition which would cause a Change in Control.

               (i) A “Non-Control Acquisition” shall mean an acquisition by (1) an employee benefit plan (or
a trust forming a part thereof) maintained by (x) the Company or (y) any corporation or other
Person of which a majority of its voting power or its equity securities or equity interest is owned
directly or indirectly by the Company (a “Subsidiary”), or (2) the Company or any Subsidiary.

               (ii) Notwithstanding the foregoing, a Change in Control shall not be deemed to occur solely
because a Person (the “Subject Person”) gained Beneficial Ownership of more than the permitted
amount of the outstanding Voting Securities as a result of the acquisition of Voting Securities by
the Company which, by reducing the number of Voting Securities outstanding, increases the
proportional number of shares Beneficially Owned by the Subject Person, provided that if a Change
in Control would occur (but for the operation of this sentence) as a result of the acquisition of
Voting Securities by the Company, and after such share acquisition by the Company, the Subject
Person becomes the Beneficial Owner of any additional Voting Securities which increases the
percentage of the then outstanding Voting Securities Beneficially Owned by the Subject Person, then
a Change in Control shall occur.

          (b) Except as otherwise provided in subparagraph 1.3(c)(i), the individuals who, as of the
date this Agreement is approved by the Board, are members of the Board (the “Incumbent Board”),
cease for any reason to constitute at least two-thirds of the Board; provided, however, that if the
election, or nomination for election by the Company’s stockholders, of any new director was
approved by a vote of at least two-thirds of the Incumbent Board, such new director shall, for
purposes of this Agreement, be considered and defined as a member of the

3

 

Incumbent Board; and provided, further, that no individual shall be considered a member of the
Incumbent Board if such individual initially assumed office as a result of either an actual
“Election Contest” (as described in Rule 14a-11 promulgated under the 1934 Act) or other
solicitation of proxies or consents by or on behalf of a Person other than the Board (a “Proxy
Contest”); or

          (c) Approval by stockholders of the Company of:

               (i) A merger, consolidation or reorganization involving the Company, unless: (1) the
stockholders of the Company, immediately before such merger, consolidation or reorganization, own,
directly or indirectly immediately following such merger, consolidation or reorganization, at least
sixty percent (60%) of the combined voting power of the outstanding voting securities of the
corporation resulting from such merger or consolidation or reorganization (the “Surviving
Corporation”) in substantially the same proportion as their ownership of the Voting Securities
immediately before such merger, consolidation or reorganization, and (2) the individuals who were
members of the Incumbent Board immediately prior to the execution of the agreement providing for
such merger, consolidation or reorganization constitute at least a majority of the members of the
board of directors of the Surviving Corporation. A transaction described in clauses (1) through
(2) shall herein be referred to as a “Non-Control Transaction”; or

               (ii) An agreement for the sale or other disposition of all or substantially all of the assets
of the Company, which sale or disposition includes the TeamStaff Government Solutions subsidiary
or operating assets, to any Person, other than a transfer to a Subsidiary, in one transaction or a
series of related transactions;

               (iii) The stockholders of the Company approve any plan or proposal for the liquidation or
dissolution of the Company.

4

 

          (d) Notwithstanding anything contained in this Agreement to the contrary, if the Employee’s
employment is terminated prior to a Change in Control and the Employee reasonably demonstrates that
such termination (i) was at the request of a third party who has indicated an intention or taken
steps reasonably calculated to effect a Change in Control (a “Third Party”) or (ii) otherwise
occurred in connection with, or in anticipation of, a Change in Control, then for all purposes of
this Agreement, the date of a Change in Control with respect to the Employee shall mean the date
immediately prior to the date of such termination of the Employee’s employment.

     1.4 Continuation Benefits. Continuation Benefits shall be the continuation of the Benefits,
as defined in Section 5.1, for the period commencing on the Termination Date and terminating six
months thereafter, or such other period as specifically stated by this agreement (the “Continuation
Period”) at the Company’s expense on behalf of the Employee and his dependents; and (ii) the level
and availability of benefits provided during the Continuation Period shall at all times be subject
to the post-employment conversion or portability provisions of the benefit plans. The Company’s
obligation hereunder with respect to the foregoing benefits shall also be limited to the extent
that if the Employee obtains any such benefits pursuant to a subsequent employer’s benefit plans,
the Company may reduce the coverage of any benefits it is required to provide the Employee
hereunder as long as the aggregate coverage and benefits of the combined benefit plans is no less
favorable to the Employee than the coverage and benefits required to be provided hereunder. This
definition of Continuation Benefits shall not be interpreted so as to limit any benefits to which
the Employee, his dependents or beneficiaries may be entitled under any of the Company’s employee
benefit plans, programs or practices

5

 

following the Employee’s termination of employment, including, without limitation, retiree
medical and life insurance benefits.

     1.5 Disability. Disability shall mean a physical or mental infirmity which impairs the
Employee’s ability to substantially perform his duties with the Company for a period of sixty (60)
consecutive days and the Employee has not returned to his full time employment prior to the
Termination Date as stated in the “Notice of Termination” (as defined below).

     1.6 Good Reason. “Good Reason” shall mean without the written consent of the Employee: (A) a
material breach of any provision of this Agreement by the Company; (B) failure by the Company to
pay when due any compensation to the Employee; (C) a reduction in the Employee’s Base Salary; (D)
failure by the Company to maintain the Employee in the positions referred to in Section 2.1 of this
Agreement; (E) assignment to the Employee of any duties materially and adversely inconsistent with
the Employee’s positions, authority, duties, responsibilities, powers, functions, reporting
relationship or title as contemplated by Section 2.1 of this Agreement or any other action by the
Company that results in a material diminution of such positions, authority, duties,
responsibilities, powers, functions, reporting relationship or title; (F) relocation of the
principal office of the Company or the Employee’s principal place of employment to a location
outside a 25 mile radius of the present location in Loganville, Georgia, without the Employee’s
written consent; or (G) a Change in Control, provided the event on which the Change of Control is
predicated occurs within 90 days of the service of the Notice of Termination by the Employee, it
being understood that Employee shall have the right to terminate his employment under this Section
1.6 (G) for any reason or no reason within such 90 day period; provided, however, that the Employee
agrees not to terminate his employment for Good Reason pursuant to clauses (A) through (G) unless
(a) the Employee has given the Company at least 30

6

 

days’ prior written notice of his intent to terminate his employment for Good Reason, which
notice shall specify the facts and circumstances constituting Good Reason; and (b) the Company has
not remedied such facts and circumstances constituting Good Reason to the reasonable and good faith
satisfaction of the Employee within a 30-day period after receipt of such notice.

     1.7 Notice of Retention. Notice of Retention shall mean a written notice from the Company to
the Employee prior to, or within ten business days after, a Change of Control stating: (A) the
Change of Control event; (B) that the Company will retain Employee in Employee’s current position
after the date of the Change of Control event; and (C) the period of time (the “Retention Period”)
not to exceed six months from the date of the Change of Control event specified in the Notice of
Retention that the Employee will be retained in Employee’s position.

     1.8 Notice of Termination. Notice of Termination shall mean a written notice from the
Company, or the Employee, of termination of the Employee’s employment which indicates the provision
in this Agreement relied upon, if any and which sets forth in reasonable detail the facts and
circumstances claimed to provide a basis for termination of the Employee’s employment under the
provision so indicated. A Notice of Termination served by the Company shall specify the effective
date of termination.

     1.9 Pro Rata Bonus. “Pro Rata Bonus” shall mean an amount equal to the lesser of (i) the
Targeted Bonus, as defined in section 4.2, multiplied by a fraction, the numerator of which shall
be the number of days from the commencement of the fiscal year to the Termination Date, and the
denominator of which shall be the number of days in the fiscal year in which Employee was
terminated; and (ii) $75,000.

     1.10 Severance Payment. “Severance Payment” shall mean an amount equal to the sum of six
months of Employee’s Base Salary in effect on the Termination Date. The Severance

7

 

Payment shall be payable in equal installments on each of the Company’s regular pay dates for
executives during the six months commencing on the first regular executive pay date following the
Termination Date. The Severance Payment is conditioned on the Employee executing a termination
agreement and release in a form reasonably acceptable to the Employee and the Company.

     1.11 Termination Date. Termination Date shall mean (i) in the case of the Employee’s death,
his date of death; (ii) in the case of Good Reason, 30 days from the date the Notice of Termination
is given to the Company, provided the Company has not remedied such facts and circumstances
constituting Good Reason; (iii) in the case of termination of employment on or after the Expiration
Date, the last day of employment; and (iv) in all other cases, the date specified in the Notice of
Termination; provided, however, if the Employee’s employment is terminated by the Company for any
reason except Cause, the date specified in the Notice of Termination shall be at least 30 days from
the date the Notice of Termination is given to the Employee, and provided further that in the case
of Disability, the Employee shall not have returned to the full-time performance of his duties
during such period of at least 30 days.

ARTICLE II

EMPLOYMENT

     2.1 Subject to and upon the terms and conditions of this Agreement, the Company hereby agrees
to employ the Employee, and the Employee hereby accepts such employment, as President of TeamStaff
Government Solutions, Inc. (f/k/a RS Staffing Services, Inc.).

ARTICLE III

8

 

DUTIES

     3.1 The Employee shall, during the term of his employment with the Company, and subject to the
direction and control of the Company’s Chief Executive Officer, perform such duties and functions
as he may be called upon to perform by the Chief Executive Officer during the term of this
Agreement, consistent with his position as President of TeamStaff Government Solutions.

     3.2 The Employee shall perform, in conjunction with the Company’s Executive Management, to the
best of his ability the following services and duties for the Company and its subsidiary
corporations (by way of example, and not by way of limitation):

          (i) Those duties attendant to the position of President of TeamStaff Government Solutions;

          (ii) Establish and implement current and long range objectives, plans, and policies, subject
to the approval of the Chief Executive Officer;

          (iii) Compliance with local, state and federal regulations and laws governing business
operations; and

          (iv) Promotion of the relationships of the Company with its employees, customers, suppliers
and others in the business community.

     3.3 The Employee agrees to devote full business time and his best efforts in the performance
of his duties for the Company and any subsidiary corporation of the Company.

9

 

     3.4 Employee shall undertake regular travel to the Company’s executive and operational
offices, and such other occasional travel within or outside the United States as is or may be
reasonably necessary in the interests of the Company. All such travel shall be at the sole cost
and expense of the Company and shall include reasonable lodging and food costs incurred by Employee
while traveling.

ARTICLE IV

COMPENSATION

     4.1 During the term of this Agreement, Employee shall be compensated initially at the rate of
$200,000 per annum, subject to such increases, if any, as determined by the Board of Directors, or
if the Board so designates, the Management Resources and Compensation Committee, in its discretion,
at the commencement of each of the Company’s fiscal years during the term of this Agreement (the
“Base Salary”). The base salary shall be paid to the Employee in accordance with the Company’s
regular executive payroll periods.

     4.2 Employee may receive a bonus in the sole discretion of the Management Resources and
Compensation Committee of the Board of Directors. Employee will have an opportunity to earn a
cash bonus (the “Targeted Bonus”) of up to 70% of Employee’s Base Salary for each fiscal year of
employment. The Bonus will be based on performance targets and other key objectives established by
the Chief Executive Officer. Thirty percent of the bonus shall be based on achieving revenue
targets, 60% shall be based on achieving EBITDA targets and 10% shall be based on achieving
corporate goals established by the Chief Executive Officer. At the sole discretion of the
Management Resources and Compensation Committee, Employee may be eligible for additional
compensation for exceeding performance targets.

10

 

     4.3 The Company shall deduct from Employee’s compensation all federal, state, and local taxes
which it may now or hereafter be required to deduct.

     4.4 Employee may receive such other additional compensation as may be determined from time to
time by the Board of Directors including bonuses and other long term compensation plans. Nothing
herein shall be deemed or construed to require the Board to award any bonus or additional
compensation.

ARTICLE V

BENEFITS

     5.1 During the term hereof, the Company shall provide Employee with the following benefits
(the “Benefits”): (i) group health care and insurance benefits as generally made available to the
Company’s senior management; and (ii) such other insurance benefits obtained by the Company and
made generally available to the Company’s senior management. The Company shall reimburse Employee,
upon presentation of appropriate vouchers, for all reasonable business expenses incurred by
Employee on behalf of the Company upon presentation of suitable documentation.

     5.2 In the event the Company wishes to obtain Key Man life insurance on the life of Employee,
Employee agrees to cooperate with the Company in completing any applications necessary to obtain
such insurance and promptly submit to such physical examinations and furnish such information as
any proposed insurance carrier may request.

     5.3 For the term of this Agreement, Employee shall be entitled to paid vacation at the rate of
four (4) weeks per annum.

ARTICLE VI

NON-DISCLOSURE

11

 

     6.1 The Employee shall not, at any time during or after the termination of his employment
hereunder, except when acting on behalf of and with the authorization of the Company, make use of
or disclose to any person, corporation, or other entity, for any purpose whatsoever, any trade
secret or other confidential information concerning the Company’s business , finances, marketing,
accounting , personnel and/or staffing business of the Company and its subsidiaries, including
information relating to any customer of the Company or pool of temporary or permanent employees,
governmental customer or any other nonpublic business information of the Company and/or its
subsidiaries learned as a consequence of Employee’s employment with the Company (collectively
referred to as the “Proprietary Information”). For the purposes of this Agreement, trade secrets
and confidential information shall mean information disclosed to the Employee or known by him as a
consequence of his employment by the Company, whether or not pursuant to this Agreement, and not
generally known in the industry. The Employee acknowledges that trade secrets and other items of
confidential information, as they may exist from time to time, are valuable and unique assets of
the Company, and that disclosure of any such information would cause substantial injury to the
Company. Trade secrets and confidential information shall cease to be trade secrets or
confidential information, as applicable, at such time as such information becomes public other than
through disclosure, directly or indirectly, by Employee in violation of this Agreement.

     6.2 If Employee is requested or required (by oral questions, interrogatories, requests for
information or document subpoenas, civil investigative demands, or similar process) to disclose any
Proprietary Information, Employee shall, unless prohibited by law, promptly notify the Company of
such request(s) so that the Company may seek an appropriate protective order.

12

 

ARTICLE VII

RESTRICTIVE COVENANT

     7.1 In the event of the voluntary termination of employment with the Company prior to the
expiration of the term hereof, or Employee’s discharge in accordance with Article IX, or the
expiration of the term hereof without renewal, Employee agrees that he will not, for a period of
one (1) year following such termination, directly or indirectly, enter into or become associated
with or engage in any other business (whether as a partner, officer, director, shareholder,
employee, consultant, or otherwise), which is involved in the business of providing (i) temporary
and/or permanent staffing of governmental employees, travel health professionals and travel nurses,
(ii) medical and office administration/technical professionals through Federal Supply Schedule
(“FSS”) contracts with both the United States General Services Administration (“GSA”), United
States Department of Veterans Affairs (“DVA”), United States Department of Defense (“DOD”) and
other federal, state and local entities, and (iii) or is otherwise engaged in the same or similar
business as the Company in direct competition with the Company, or which the Company was in the
process of developing, during the tenure of Employee’s employment by the Company. Notwithstanding
the foregoing, the ownership by Employee of less than five percent of the shares of any publicly
held corporation shall not violate the provisions of this Article VII. In furtherance of the
foregoing, Employee shall not during the aforesaid period of non-competition, directly or
indirectly, in connection with any temporary or permanent employee placement or other business of
the Company and its subsidiaries, including information relating to any customer of the Company or
pool of temporary employees, or any other nonpublic business information , or any business similar
to the business in which the Company was engaged, or in the process of developing during Employee’s
tenure with the Company, solicit any customer or

13

 

employee of the Company who was a customer or employee of the Company during the tenure of his
employment.

     7.2 If any court shall hold that the duration of non-competition or any other restriction
contained in this Article VII is unenforceable, it is our intention that same shall not thereby be
terminated but shall be deemed amended to delete therefrom such provision or portion adjudicated to
be invalid or unenforceable or, in the alternative, such judicially substituted term may be
substituted therefor.

ARTICLE VIII

TERM

     8.1 This Agreement shall be for a term (the “Initial Term”) commencing on October 1, 2008 (the
“Commencement Date”) and terminating on September 30, 2010 (the “Expiration Date”), unless sooner
terminated upon the death of the Employee, or as otherwise provided herein.

ARTICLE IX

TERMINATION

     9.1 The Company may terminate this Agreement by giving a Notice of Termination to the Employee
in accordance with this Agreement:

	 	(i)	 	for Cause;
	 
	 	(ii)	 	without Cause;
	 
	 	(iii)	 	for Disability.

     9.2 Employee may terminate this Agreement by giving a Notice of Termination to the Company in
accordance with this Agreement, at any time, with or without good reason.

     9.3 If the Employee’s employment with the Company shall be terminated, the

14

 

Company shall pay and/or provide to the Employee the following compensation and benefits in
lieu of any other compensation or benefits arising under this Agreement or otherwise:

          (i) if the Employee was terminated by the Company for Cause, or the Employee terminates
without Good Reason, the Accrued Compensation;

          (ii) if the Employee was terminated by the Company for Disability,

	 	(a)	 	the Continuation Benefits;
	 
	 	(b)	 	the Accrued Compensation;
	 
	 	(c)	 	the Pro-Rata Bonus; and
	 
	 	(d)	 	the Severance Payment; or

          (iii) if termination was due to the Employee’s death,

	 	(a)	 	the Accrued Compensation;
	 
	 	(b)	 	the Continuation Benefits;
	 
	 	(c)	 	and the Pro Rata Bonus; or

          (iv) if the Employee was terminated by the Company without cause, or the Employee terminates
this Agreement for Good Reason,

	 	(a)	 	the Accrued Compensation;
	 
	 	(b)	 	the Severance Payment; and
	 
	 	(c)	 	the Continuation Benefits.

     9.4 The amounts payable under this Section 9, shall be paid as follows:

          (i) Accrued Compensation shall be paid within five (5) business days after the Employee’s
Termination Date (or earlier, if required by applicable law).

          (ii) If the Continuation Benefits are paid in cash, the payments shall be made on the first
day of each month during the Continuation Period (or earlier, if required by applicable

15

 

law).

          (iii) The Base Salary through the Expiration Date shall be paid in accordance with the
Company’s regular pay periods (or earlier, if required by applicable law).

     9.5 The Employee shall not be required to mitigate the amount of any payment provided for in
this Agreement by seeking other employment or otherwise and no such payment shall be offset or
reduced by the amount of any compensation or benefits provided to the Employee in any subsequent
employment except as provided in Sections 1.4.

ARTICLE X

TERMINATION OF PRIOR AGREEMENTS

     10.1 This Agreement sets forth the entire agreement between the parties and supersedes all
prior agreements, letters and understandings between the parties, whether oral or written prior to
the effective date of this Agreement except for the terms of employee stock option plans,
restricted stock grants and option certificates.

ARTICLE XI

RESTRICTED STOCK GRANTS

     11.1 The Company hereby grants to Employee 30,000 restricted shares of the Company’s Common
Stock, $.001 par value subject to the provisions of the Company’s 2006 Long Term Incentive Plan
(the “Plan”).

     11.2 One-third of such shares shall vest upon the execution of this agreement. One-third
shall vest on September 30, 2009, upon satisfaction of the performance targets and other key
objectives established by the Chief Executive Officer for 2009 for Employee’s Targeted Bonus; and
one-third of such shares shall vest on September 30, 2010 upon the satisfaction of the performance
targets for the Targeted Bonus for 2010. If Employee renders continuous service to

16

 

the Company from the date hereof to a vesting date, on each such vesting date the Company
shall deliver to Employee such number of shares of Common Stock as shall vest on such date.

     11.3 In the event of a Change of Control, as defined in Section 1.3, the conditions to the
vesting of any outstanding Restricted Stock Awards granted to the Employee under this Article XI
shall be deemed void and all such Shares shall be immediately and fully vested and delivered to the
Employee.

ARTICLE XII

EXTRAORDINARY TRANSACTIONS

     12.1 The Company’s Board of Directors has determined that it is appropriate to reinforce and
encourage the continued attention and dedication of members of the Company’s management, including
the Employee, to their assigned duties without distraction in potentially disturbing circumstances
arising from the possibility of a change in control of the Company.

     In the event that within ninety days (90) days of a Change of Control, (i) Employee is
terminated, or (ii) Employee’s status, title, position or responsibilities are materially reduced
and Employee terminates his Employment, the Company shall pay and/or provide to the Employee, the
following compensation and benefits:

	 	a.	 	The Company shall pay the Employee, in lieu of any other
payments due hereunder, (i) the Accrued Compensation; (ii) the Continuation
Benefits; and (iii) as severance, Base Salary for a period of six (6) months
payable in equal installments on each of the Company’s regular pay dates for
executives during the six months commencing on the first regular executive pay
date following the termination Date; and

17

 

	 	b.	 	The conditions to the vesting of any outstanding incentive
awards (including restricted stock, stock options and granted performance
shares or units) granted to the Employee under any of the Company’s plans, or
under any other incentive plan or arrangement, shall be deemed void and all
such incentive awards shall be immediately and fully vested and exercisable.

     12.4 In the event the Company serves a Notice of Retention, and Employee diligently performs
Employee’s duties during the Retention Period, the Company shall pay Employee, in one lump sum on
the first day of the month immediately following the month in which the Retention Period ends, an
amount equal to 50% of Employee’s then current Base Salary. In the event the Company fails to
serve a Notice of Retention, the Company shall pay Employee, in one lump sum on the first day of
the month immediately following the Change of Control, an amount equal to 50% of Employee’s then
current Base Salary.

     12.5 Notwithstanding the foregoing, if the payment under this Article XII, either alone or
together with other payments which the Employee has the right to receive from the Company, would
constitute an “excess parachute payment” as defined in Section 280G of the Internal Revenue Code of
1986, as amended (the “Code”), the aggregate of such credits or payments under this Agreement and
other agreements shall be reduced to the largest amount as will result in no portion of such
aggregate payments being subject to the excise tax imposed by Section 4999 of the Code. The
priority of the reduction of excess parachute payments shall be in the discretion of the Employee.
The Company shall give notice to the Employee as soon as practicable after its determination that
Change of Control payments and benefits are subject to the excise tax, but no later than ten (10)
days in advance of the due date of such Change of Control payments and benefits, specifying the
proposed date of payment and the Change of Control benefits and

18

 

payments subject to the excise tax. Employee shall exercise his option under this paragraph
12.4 by written notice to the Company within five (5) days in advance of the due date of the Change
of Control payments and benefits specifying the priority of reduction of the excess parachute
payments.

ARTICLE XIII

ARBITRATION AND INDEMNIFICATION

     13.1 Any dispute arising out of the interpretation, application, and/or performance of this
Agreement with the sole exception of any claim, breach, or violation arising under Articles VI or
VII hereof shall be settled through final and binding arbitration before a single arbitrator in the
State of New Jersey in accordance with the Rules of the American Arbitration Association. The
arbitrator shall be selected by the Association and shall be an attorney-at-law experienced in the
field of corporate law. Any judgment upon any arbitration award may be entered in any court,
federal or state, having competent jurisdiction of the parties.

     13.2 The Company hereby agrees to indemnify, defend, and hold harmless the Employee for any
and all claims arising from or related to his employment by the Company at any time asserted, at
any place asserted, to the fullest extent permitted by law, except for claims based on Employee’s
fraud, deceit or willfulness. The Company shall maintain such insurance as is necessary and
reasonable to protect the Employee from any and all claims arising from or in connection with his
employment by the Company during the term of Employee’s employment with the Company and for a
period of six (6) years after the date of termination of employment for any reason. The provisions
of this Section 13.2 are in addition to and not in lieu of any indemnification, defense or other
benefit to which Employee may be entitled by statute, regulation, common law or otherwise.

19

 

ARTICLE XIV

SEVERABILITY

     If any provision of this Agreement shall be held invalid and unenforceable, the remainder of
this Agreement shall remain in full force and effect. If any provision is held invalid or
unenforceable with respect to particular circumstances, it shall remain in full force and effect in
all other circumstances.

ARTICLE XV

NOTICE

     For the purposes of this Agreement, notices and all other communications provided for in the
Agreement shall be in writing and shall be deemed to have been duly given when (a) personally
delivered or (b) sent by (i) a nationally recognized overnight courier service or (ii) certified
mail, return receipt requested, postage prepaid and in each case addressed to the respective
addresses as set forth below or to any such other address as the party to receive the notice shall
advise by due notice given in accordance with this paragraph. All notices and communications shall
be deemed to have been received on (A) if delivered by personal service, the date of delivery
thereof; (B) if delivered by a nationally recognized overnight courier service, on the first
business day following deposit with such courier service; or (C) on the third business day after
the mailing thereof via certified mail. Notwithstanding the foregoing, any notice of change of
address shall be effective only upon receipt.

     The current addresses of the parties are as follows:

	 	 	 	 	 
	 

	 	IF TO THE COMPANY:
	 	TeamStaff, Inc.
	 

	 	 	 	1 Executive Drive
	 

	 	 	 	Somerset, NJ 08873

20

 

	 	 	 	 	 
	 

	 	WITH A COPY TO:
	 	Victor J. DiGioia
	 

	 	 	 	Becker & Poliakoff, LLP
	 

	 	 	 	45 Broadway
	 

	 	 	 	New York, NY 10006
	 
	 	 	 	 
	 

	 	IF TO THE EMPLOYEE:	 	 

ARTICLE XVI

BENEFIT

     This Agreement shall inure to, and shall be binding upon, the parties hereto, the successors
and assigns of the Company, and the heirs and personal representatives of the Employee.

ARTICLE XVII

WAIVER

     The waiver by either party of any breach or violation of any provision of this Agreement shall
not operate or be construed as a waiver of any subsequent breach of construction and validity.

ARTICLE XVIII

GOVERNING LAW

     This Agreement has been negotiated and executed in the State of New Jersey which shall govern
its construction and validity.

21

 

ARTICLE XIX

JURISDICTION

     Any or all actions or proceedings which may be brought by the Company or Employee under this
Agreement shall be brought in courts having a situs within the State of New Jersey, and Employee
and the Company each hereby consent to the jurisdiction of any local, state, or federal court
located within the State of New Jersey.

ARTICLE XX

ENTIRE AGREEMENT

     This Agreement contains the entire agreement between the parties hereto. No change, addition,
or amendment shall be made hereto, except by written agreement signed by the parties hereto.

     IN WITNESS WHEREOF, the parties hereto have executed this Agreement and affixed their hands
and seals the day and year first above written.

	 	 	 	 	 
	 	TEAMSTAFF, INC.

 	 
	 	By:  	/s/ Rick Filippelli
 	 
	 	 	Rick Filippelli 	 
	 	 	Chief Executive Officer 	 
	 
	 	 	 
	 	/s/ Kevin Wilson
 	 
	 	Kevin Wilson 	 
	 	Employee 	 
	 

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