Delta Dental of Minnesota
Independent Producer Dental Commission Agreement
Parthfinder Product

This Agreement, made this day of , 20 by and between Delta Dental of Minnesota, hereinafter "DELTA
DENTAL", and , hereinafter "BROLER/AGENCY", covers the following programs:

POOL Rated Programs

Pool rated groups include any DELTA DENTAL dental program sold on a pool rated basis. All pool rated groups covered by this Agreement are sold at rates pre-
established by DELTA DENTAL.

Unless otherwise negotiated, DELTA DENTAL agrees to pay said BROKE/AGENCY 10% commission of the first year's, 7% commission of the second year's,
and subsequent year's premium paid in cash to DELTA DENTAL under DELTA DENTAL's Master Dental Group Contract Application and on and for the behalf
of any qualified group administrator designating said BROKER/AGENCY as "Broker/Agency of Record" per DELTA DENTAL's Master Dental Contract
Application signed by such qualified group administrator and BROKER/AGENCY.

INDIVIDUAL Rated Programs

Unless otherwise negotiated, DELTA DENTL agrees to establish a commission rate based upon projected annual revenue at the time of underwriting and pay
said BROKER at the established rate on first year and subsequent years premium pais in cash to DELTA DENTAL under any individually rated group dental
program sold by DELTA DENTAL on which DELTA DENTAL is advised in advance of quoting rates that the BROKER is designated as Broker of Record for
the specific group.

Commission subject to the term and conditions o the Agreement, shall be paid to the BROKER/AGENCY as long as BROKER/AGENCY:

(1) is continuously and actively engaged as a licensed BROKER/AGENCY;
(2) continues to be designated by the group named in the Master Dental Group Contract as the BROKER/AGENCY with respect to such group;
(3) services the group in a manner satisfactory to DELTA DENTAL; and,
(4) the original Master Dental Group Contract for which this Agreement is executed has not been terminated.

Upon receipt of a completed and signed Taxpayer Identification Number Request or W-9 Form, commission shall be payable to the extent respective dues are
paid DELTA DENTAL within thirty (30) days after the end of the Calendar Month. If a premium adjustment shall be made for any period, then a corresponding
adjustment shall be made in BROKER's/AGENCIES commission for such period and adjustment made on next commission payment or refunded at DELTA
DENTAL's option.

Any indebtedness of BROKER/AGENCY to DELTA DENTAL shall be first lien against any commission due paid BROKER/AGENCY o his representative or
assigns under this Agreement and such commissions shall be applied to liquidate such indebtedness.

No assignment, transfer or disposal of any interest that BROKER/AGENCY may have on account of the Agreement shall be made at any time without written
approval of DELTA DENTAL.

DELTA DENTAL may, as its option, be responsible for enrolling and servicing the group and BROKER/AGENCY hereby agrees to abide by the elected option of
DELTA DENTAL, however, in either event, BROKER/AGENCY agrees to render satisfactory services as directed by DELTA DENTAL.

By signing this Agreement, I represent that I am a duty licensed insurance agent by the State of Minnesota and that no disciplinary actions are pending against me.