< I, the undersigned > hereby designate Jake Dayton as Agent of Record, effective immediately, with respect to the medical and/or dental insurance product(s) purchased from SelectHealth. In making this designation, it is required that SelectHealth pay any and all commissions and/or fees payable from the effective date forward to the Agent of Record.

It is understood that the Agent of Record is the exclusive representative to act on behalf of the client to:

1. Solicit insurance proposals from you, and

2. Review proposals and make recommendations in assisting the client in achieving their goals.

I, the client, hereby represent that in issuing this Agent of Record letter, the Agent of Record has not given, paid, provided, or promised any benefit, inducement, or compensation in any form other than services directly supporting your medical and/or dental insurance product(s). Further, no representation has been made that the Agent of Record can obtain a premium rate more favorable to our company than is available through any other appointed agent for the same coverage, benefit, or program.

I, the agent, understand that the terms and conditions of this appointment will be subject to the specific contractual requirements of SelectHealth, as well as normal agent appointment procedures.

Questions about coverage or proposed benefit changes, as well as any fees and commissions, should be directed to:

Agent Name: Jake Dayton

Phone: 801-797-3118

Agency Name: Dayton Management Inc

Address: 368 W 625 N, Lindon, UT, 84042