FELED yee . May 13> 2005 DEPARTMENT OF FINANCIAL SERVICES 20 PH Mt TOM GALLAGHER ava CHIEF FINANCIAL OFFICER A Mf fh " HE IN THE MATTER OF: CASE NO. 67168-03-AG DORA LEONORA SMITH / D%- DAIS PL ADMINISTRATIVE COMPLAINT TO: DORA LEONORA SMITH 12620 US Hwy 301 Dade City, Florida 33525 DORA LEONORA SMITH 5422 Emerald Drive Ridgemanor, Florida 33523 You, DORA LEONORA SMITH, are hereby notified that pursuant to Chapter 626, Florida Statutes, the Chief Financial Officer of the State of Florida, has caused to be made an investigation of your activities while licensed as an insurance agent in this state, as a result of which it is alleged: GENERAL ALLEGATIONS 1. You, DORA LEONORA SMITH, are currently licensed in the state as a general lines insurance agent, and as a legal expense agent. 2. At all time pertinent to the dates and occurrences referred to in this Administrative Complaint you, DORA LEONORA SMITH, were licensed as an insurance agent in this state. 3. At all times pertinent to the dates and occurrences referred to in this Administrative Complaint you, DORA LEONORA SMITH, were an officer and director of Gene Smith Insurance Agency, Inc., a Florida incorporated insurance agency. 4. At all times pertinent to the dates and occurrences referred to in this Administrative Complaint all funds received by you, DORA LEONORA SMITH, pursuant to Section 626.561, Florida Statutes, from consumers or on behalf of consumers were trust funds received in a fiduciary capacity and were to be paid over to persons entitled thereto in the regular course of business. COUNT I 5. Paragraphs one through four are realleged and incorporated herein by reference. 6. On or about January 31, 2002, you, DORA LEONORA SMITH, received from Mark Romano of Ridge Manor, Florida a check in the amount of $172.00 made payable to Gene Smith Insurance. These funds were intended by Mark Romano to be an initial premium payment on a boat owners marine insurance policy. You, DORA LEONORA SMITH, represented to Mark Ramono that his boat was insured from January 31, 2002. Mark Romano made two additional premium payments on February 28, 2002 and March 29, 2002 to a premium finance company. 7. You, DORA LEONORA SMITH, submitted the application and premium payment for Mark Romano’s marine insurance policy to Hull & Co., an insurance broker, for processing and issuance of the policy. On or about February 28, 2002, Hull & Co informed you, DORA LEONORA SMITH, that additional information would be needed before coverage could be bound and a policy issued. You, DORA LEONORA SMITH, failed to provide the requested information to Hull & Co. or inform Mark Romano that additional information was required and 2 that his insurance policy had not been issued. On or about March 7, 2002, Hull & Co. made a second request to you, DORA LEONORA SMITH, for information but you failed to respond. 8. On or about March 18, 2002, Hull & Company returned your agency check representing the policy premium payment uncashed to you, DORA LEONORA SMITH, and informed you that Mark Romano’s insurance policy could not be issued because you had failed to provide the requested information. You, DORA LEONORA SMITH, failed to inform Mark Romano that his insurance policy had not been issued and failed to refund the premium payment to Mark Romano or to the premium finance company. 9. You, DORA LEONORA SMITH, represented to Mark Romano that his boat was fully insured until April 8, 2002, when his boat sank. These representations were false and material misstatements of fact. At the time these representations were made, no insurance company had issued a marine insurance policy to Mark Romano and no insurance coverage had been bound. You, DORA LEONORA SMITH, were aware of these facts but failed to inform Mark Romano. As a result, he has suffered a significant financial loss. IT IS THEREFORE CHARGED that you, DORA LEONORA SMITH, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Financial Services which constitute grounds for the suspension or revocation of your insurance licenses and eligibility for licensure: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract. {Section 626.611(5), Florida Statutes}; (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (c) Fraudulent or dishonest practices in the conduct of business under the license or permit. [Section 626.611(9), Florida Statutes]; (d) In the conduct of business under the license or permit, engaging in unfair methods of competition or in unfair or deceptive acts or practices, as prohibited under part X of this chapter, or having otherwise shown himself to be a source of injury or loss to the public. [Section 626.621(6), Florida Statutes] (e) False statements and entries. — 1. Knowingly: a. Filing with any supervisory or other public official, b. Making, publishing, disseminating, circulating, c. Delivering to any person, d. Placing before the public, e, Causing, directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public, any false material statement. [Section 626.9541(1)(e)1, Florida Statutes]. NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Department pursuant to sections 120.569 and 120.57, Florida Statutes, and Rule 28-107, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be filed with the Department within twenty-one (21) days of your receipt of this notice. Completion of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with the General Counsel as acting Agency Clerk, at the Florida Department of Financial Services, 612 Larson Building, 200 East 4 Gaines Street, Tallahassee, Florida 32399-0333. Your written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after your receipt of this notice. Mailing the response on the twenty-first day will not preserve your right to a hearing. YOUR FAILURE TO RESPOND IN WRITING WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU. If you request a proceeding, you must provide information that complies with the requirements of Rule 28-107.004, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements. Specifically, your response must contain: (a) The name and address of the party making the request, for purpose of service; (b) A statement that the party is requesting a hearing involving disputed issues of material fact, or a hearing not involving disputed issues of material fact; and (c) A reference to the notice, order to show cause, administrative complaint, or other communication that the party has received form the agency. If a hearing of any type is requested, you have the right to be represented by counsel or other qualified representative at your expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. If a proceeding is requested and there is no dispute of material fact, the provisions of section 120.57(2), Florida Statutes, apply. In this regard, you may submit oral or written evidence in opposition to the action taken by the Department or a written statement challenging ene mt me ames ete ame SEER: ORTH w= the grounds upon which the Department has relied. While a hearing is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary, one will be conducted in Tallahassee, Florida, or by telephonic conference call upon your request. However, if you dispute material facts which are the basis for the Department’s action, you must request an adversarial proceeding pursuant to sections 120.569 and 120.57(1), Florida Statutes. These proceedings are held before a State administrative law judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere, the Department will request that the hearing be conducted in Tallahassee, Florida. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding. Any request for an administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. Mediation of this matter pursuant to section 120.573, Florida Statutes, is not available. No Department attorney will discuss this matter with you until the response has been received by the Department of Financial Services. DATED this 43th gayof May , 2003. KAREN CHANDLER Deputy Chief Financial Officer CERTIFICATE OF SERVICE SLATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Administrative Complaint was mailed by certified mail to: DORA LEONORA SMITH, 12620 US Hw Dade City, y 301, FL 33525 and to DORA LEONORA SMITH at 5422 Emerald Drive, Ridgemanor, FL 33523 on this 13th dayof May , 2003. > Division of Legal Services 612 Larson Building Tallahassee, FL 32399-0333 (850) 413-4125

Docket for Case No: 03-002395PL