The undersigned grants permission to KEMI to release a copy of the audit worksheets to the insured’s agent/broker.

The undersigned, by signing this Audit Worksheet Release Form, represents that he/she has the authority to grant such permission to permit the release of copies of audit worksheets to the insured’s agent/broker.

It is further understood that this release form will remain in effect for the duration of the insured’s policy with KEMI until such time that: 1) an agent of record change has been completed or 2) a written request to rescind this authorization has been provided to KEMI.