Logo Request Form

As the principal agent, I have the authority to act on behalf of this agency and enter into this Agreement. Furthermore, I understand that it is my responsibility to ensure that all employees and/or independent contractors who work on behalf of this agency are aware and will adhere to the terms outlined in this Agreement. In all interactions with Kentucky Employers’ Mutual Insurance (KEMI), we understand that we are acting on behalf of the insured or prospective insured and will advise the insured or prospective insured of the same. As independent agents, we have no binding authority with KEMI. We have no authority to extend, alter or expand coverage with KEMI. We will use KEMI’s logo in a way that is in compliance with all federal, state and local laws. If requested by KEMI, we will cease using KEMI’s logo. We will not share KEMI’s logo with any other individual or agency.