FLORIDA DEPARTMENT OF FINANCIAL SERVICES FILED TOM GALLAGHER ; OCT 25 2004 4j 9 IN THE MATTER OF: Docketod we YE, CASE NO.: 68743-04-AG O4-4 299 L. DAVID GILLUM ADMINISTRATIVE COMPLAINT TO: L.DAVID GILLUM PFS-Property & Casualty 827 Cypress Parkway Kissimmee, FL 34759-3408 L. DAVID GILLUM 4050 Citrus Street Kissimmee, Florida 34746-3704 You, L. DAVID GILLUM, license I.D. #4097403, are hereby notified that 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. Pursuant to Chapter 626, Florida Statutes (2003), you, L. DAVID GILLUM, are currently licensed in this state as a Life Including Variable Annuity Agent (2-14), a Life Including Variable Annuity & Health Agent (2-15), a Life Agent (2-16), a Life & Health Agent (2-18), a General Lines (Property & Casualty) Agent (2-20), and a Health Agent (2-40). 2. At all times pertinent to the dates and occurrences referred to herein, you, L. DAVID GILLUM, were licensed in this state as a Life Including Variable Annuity Agent (2-14), a Life Including Variable Annuity & Health Agent (2-15), a Life Agent (2-16). a Life & Health Agent (2-18), and a Health Agent (2-40). 3. On August 21, 2002, you, L. David Gillum, were licensed in this state as a General Lines (Property & Casualty) Agent (2-20). 4, Pursuant to Chapter 626, Florida Statutes (2003), the Florida Department of Financial Services (hereinafter “Department”) has jurisdiction over your insurance licenses and appointments. 5. On or about April 30, 2002, you, L. DAVID GILLUM, were listed as an officer of PFS- Property & Casualty, Inc., (hereinafter "PFS"), a Florida Profit Corporation, doing business in this state as an incorporated insurance agency. 6. As of April 30, 2002, you, L. DAVID GILLUM, were not licensed in the state of Florida as a general lines (property and casualty: 2-20) insurance agent, and were not licensed as such until August 21, 2002. 7, Beginning sometime in May 2002, until approximately September 2002, Adele Keck, a licensed general lines agent, became associated with PFS as a part-time employee. Adele Keck was never officially listed with the State of Florida as an officer, primary agent, or agent of PFS. 8. Pursuant to the requirements of Section 626.7315, Florida Statutes (2002), no individual may transact general lines insurance unless licensed as a general lines agent. 9. Pursuant to the requirements of Section 626.732(1)(c), Florida Statutes (2002), no applicant for a general lines (2-20) insurance license shall be qualified or licensed unless the applicant has completed at least one year in responsible insurance duties as a substantially full- time bona fide employee in all lines of property and casualty insurance, as set Zorth in the definition of a general lines agent under s. 626.015, without the education requirement mentioned in Sections 626.732(1){a) or 626.732(1)(b), Florida Statutes (2002). COUNT I 10. The above general allegations are hereby realleged and fully incorporated herein by reference. 11. Prior to your appointment as an officer of PFS on or about April 30, 2002, you, L. DAVID GILLUM, had no role in the general lines insurance business of PFS, nor of the general lines insurance business of any other agency. 12. Onor about July 17, 2002, you, L. DAVID GILLUM, submitted an application for a general lines (2-20) license to the Florida Department of Insurance (now the Florida Department of Financial Services). Pursuant to the application, and pursuant to Section 626.732(1)(c), Florida Statutes (2002), you also submitted an Agents Qualification and Verification of Experience form. You signed your name to this document verifying that you had been employed in general lines insurance as a substantially full-time bona fide employee for at least one year. IT IS THEREFORE CHARGED that you, L. DAVID GILLUM, 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 license and appointments: (a) Lack of one or more of the qualifications for the license or appointment as specified in this code. Section 626.611(1), Florida Statutes (2002). (b) Material misstatement, misrepresentation, or fraud in obtaining the license or appointment or in attempting to obtain the license or appointment. Section 626.61 1(2), Florida Statutes (2002). (c) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. Section 626.611(7), Florida Statutes (2002). (a) Willful failure to comply with, or willful violation of, any proper order or rule of the Department or willful violation of any provision of this code. Section 626.611(13), Florida Statutes (2002). (e) Any cause for which issuance of the license or appointment could have been refused had it then existed and been known to the department. Section 626.621(1), Florida Statutes (2002). (f) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. Section 626.621(2), Florida Statutes (2002). (g) 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 IX this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public or detrimental to the public interest. Section 626.621(6), Florida Statutes (2002). (h) Knowingly filing with any supervisory or other public official, or otherwise 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), Florida Statutes (2002). COUNT II 13. The above general allegations are hereby realleged and fully incorporated herein by reference. 14. On or about August 6, 2002, you, L. DAVID GILLUM, sold to T.W. and her husband, of Orlando, Florida both an automobile insurance policy and a homeowners insurance policy. 15. You, L. DAVID GILLUM, sold these policies to T.W. and her husband despite the fact that your were not licensed as a general lines (2-20) agent as of August 6, 2002. IT IS THEREFORE CHARGED that you, L. DAVID GILLUM, 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 license and appointments: (a) No agent shall solicit or otherwise transact as agent, or represent or hold himself or herself out to be an agent as to, any kind or kinds of insurance as to which he or she is not then licensed and appointed. Section 626.112(2), Florida Statutes (2002). (6) Lack of one or more of the qualifications for the license or appointment as specified in this code. Section 626.611(1), Florida Statutes (2002). (c) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. Section 626.611(7), Florida Statutes (2002). (d) | Demonstrated lack of reasonably adequate knowledge and technical competence to engage in the transactions authorized by the license or appointment. Section 626.611(8), Florida Statutes (2002). (e) Fraudulent or dishonest practices in the conduct of business under the license or appointment. Section 626.611(9), Florida Statutes (2002). (f) Willful failure to comply with, or willful violation of, any proper order or rule of the Department or willful violation of any provision of this code. Section 626.611(13), Florida Statutes (2002). (g) Any cause for which issuance of the license or appointment could have been refused had it then existed and been known to the department. Section 626.621(1), Florida Statutes (2002). (h) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. Section 626.621(2), Florida Statutes (2002). (i) 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 IX this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public or detrimental to the public interest. Section 626.621(6), Florida Statutes (2002). (j) With respect to any line of authority as defined in s. 626.015(7), no individual shall, unless licensed as a general lines agent, solicit insurance or procure applications therefor. Section 626.7315, Florida Statutes (2002). COUNT Il 16. The above general allegations are hereby realleged and fully incorporated herein by reference. 17. In or around March 1998, C.S. of Orlando, Florida, was introduced to you, L.DAVID GILLUM, whereupon you sold him, and his wife, variable life and survivor policies. 18. You, L. DAVID GILLUM, represented to C.S., and his wife, that there were certain tax advantages to these policies, and implied that these policies were equity building security investments, and not an insurance product. You also represented that the policies could expect thirty percent (30%) returns on investment. 19. You, L. DAVID GILLUM, failed to disclose that there were significant surrender fees for these policies, and failed to disclose that there could not only be a lower rate of appreciation, but there could be a loss of principal investment as well. 20. C.S., as a result of representations made by you, L. DAVID GILLUM, was under the impression that he could change premium and face value amounts of the policies as needed to reflect changes in his family's circumstances; this turned out not to be possible (without the incurring of significant fees and/or penalties). When C.S.'s spouse lost her job and the family did not have the income they previously had, they sought to lower their monthly payments to these products, as they thought they could: having been so informed by you, L. DAVID GILLUM. C.S. discovered that they only change that could be made were to surrender the policies altogether, for as much as a fifty percent (50%) surrender charge, or to significantly reduce the face value of the policies, either way resulting in a substantial loss of earlier investment principal. C.S. discovered these problems associated with the policies sold by you, L. DAVID GILLUM, in or around December 2000. IT IS THEREFORE CHARGED that you, L. DAVID GILLUM, 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 license and appointments: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. Section 626.611(5), Florida Statutes (1997). (b) | Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. Section 626.611(7), Florida Statutes (1997). (c) Demonstrated lack of reasonably adequate knowledge and technical competence to engage in the transactions authorized by the license or appointment. Section 626.61 1(8), Florida Statutes (1997). (d) Fraudulent or dishonest practices in the conduct of business under the license or appointment. Section 626.611(9), Florida Statutes (1997). (e) Willful failure to comply with, or willful violation of, any proper order or rule of the Department or willful violation of any provision of this code. Section 626.511(13), Florida Statutes (1997). (f} Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. Section 626,621(2), Florida Statutes (1997). (g) Violation of the provision against twisting, as defined in s. 626.9541(1)(). Section 626.621(5), Florida Statutes (1997). th} 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 this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public or detrimental to the public interest. Section 626.621(6), Florida Statutes (1997). @ Ifa life agent, violation of the code of ethics. Section 626.621(9), Florida Statutes (1997). Q Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which misrepresents the benefits, advantages, conditions, or terms of any insurance policy. Section 626.9541(1)(a), Florida Statutes (1997). (k) Knowingly making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading. Section 626.9541(1)(b), Florida Statutes (1997). (dl) 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), Florida Statutes (1997). (m) Knowingly making a false or fraudulent written or oral statement or representation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual. Section 626.9541(1)(k), Florida Statutes (1997). (n) Knowingly making any misleading misrepresentations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance in another insurer. Section 626.9541(1)(), Florida Statutes (1997). COUNT IV 21. The above general allegations are hereby realleged and fully incorporated herein by reference. 22. In or around 1993, you, L. DAVID GILLUM, sold to J.M. of Clermont, Florida, an insurance product from the Equitable, for FIVE THOUSAND AND 00/100 ($5,000) DOLLARS. However, based upon representations by you, she was under the impression that what she was purchasing was an annuity like she desired to purchase, and not an insurance policy. IT IS THEREFORE CHARGED that you, L. DAVID GILLUM, 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 license and appointments: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. Section 626.611(5), Florida Statutes (1993). (b) | Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. Section 626.611(7), Florida Statutes (1993). (c) Demonstrated lack of reasonably adequate knowledge and technical competence to engage in the transactions authorized by the license or appointment. Section 626.611(8), Florida Statutes (1993). (d) Fraudulent or dishonest practices in the conduct of business uncer the license or appointment. Section 626.611(9), Florida Statutes (1993). 10 (e) Willful failure to comply with, or willful violation of, any proper order or rule of the Department or willful violation of any provision of this code. Section 626.611(13), Florida Statutes (1993). (f) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. Section 626.621(2), Florida Statutes (1993). (g) Violation of the provision against twisting, as defined in s. 626.9541(1)(1). Section 626.621(5), Florida Statutes (1993). (bh) 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 this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public or detrimental to the public interest. Section 626.621(6), Florida Statutes (1993). (i) Ifa life agent, violation of the code of ethics. Section 626.621(9), Florida Statutes (1993). (Gy Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which misrepresents the benefits, advantages, conditions, or terms of any insurance policy. Section 626.9541(1)(a), Florida Statutes (1993). (k) Knowingly making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading. Section 626.9541(1)(b), Florida Statutes (1993). 11 d) 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), Florida Statutes (1993). (m) Knowingly making a false or fraudulent written or oral statement or representation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual. Section 626.9541(1)(k), Florida Statutes (1993). (n) Knowingly making any misleading misrepresentations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance in another insurer. Section 626.9541(1)(1), Florida Statutes (1993). COUNT V 23. The above general allegations are hereby realleged and fully incorporated herein by reference. 24. On or about March 29, 1999, you, L. DAVID GILLUM, met with D.V. of Clermont, Florida, and sold him a variable life insurance policy from the Equitable, which you represented to him as an annuity. D.V. and his spouse believed, based upon your representations, that they were purchasing a retirement investment, which merely had a life insurance product attached to it, and as such the bulk of their investment contributions would go towards an annuity for their retirement, and not towards the life insurance policy. They further understood that they could make changes, as needed, to the premium amounts and the face value 12 of the policy, without problem or fees. The initial premium payment, which was paid by D.V., was FIFTEEN THOUSAND AND 00/100 ($15,000) DOLLARS. 25. On or about April 12, 2000, D.V.'s spouse wrote a letter to cancel the policy, whereupon, you, L. DAVID GILLUM, advised D.V. and his spouse that if the policy were to cancel, they would not receive back their initial investment of FIFTEEN THOUSAND AND 00/100 ($15,000) DOLLARS, but instead only get back approximately TWO THOUSAND FIVE HUNDRED AND 00/100 ($2,500) DOLLARS. Faced with this potential loss, D.V. decided to maintain his policy but desired to make changes regarding the face value of it and its premium payments. 26. On or about April 12, 2001, D.V. met with you, L. DAVID GILLUM, to enact changes to his policy: specifically to reduce the face value and lower the premium payments of the policy. You provided paperwork for such changes which he signed and returned to you. You, L. DAVID GILLUM, provided D.V. with a faxed confirmation of the changes D.V. had requested, and advised him that the changes would be effective May 14, 2001. 27. On or about July 18, 2001, D.V. discovered upon Equitable's website, that no changes had ever been made to his policy, whereupon he advised you, L. DAVID GILLUM, and/or your office of this oversight. Upon checking again in August and September 2001, D.V. found that the changes, originally made in May 2001, still had not been made. During this time, D.V. continued with his premium payments in order to prevent a lapse in coverage. 28. In or around September 2001, D.V. began to be assessed fees on his Equitable policy that would not have been assessed had his policy change been effected properly and timely. 13 29. On or about December 26, 2001, D.V. was finally able to resolve this matter and have the policy changed as he requested in May 2001, by contacting the Equitable directly and dealing with the insurer himself. IT IS THEREFORE CHARGED that you, L. DAVID GILLUM, 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 license and appointments: (a) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. Section 626.611(5), Florida Statutes (1999). (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. Section 626.611(7), Florida Statutes (1999). (c) Demonstrated lack of reasonably adequate knowledge and technical competence to engage in the transactions authorized by the license or appointment. Section 626.611(8), Florida Statutes (1999). (cd) Fraudulent or dishonest practices in the conduct of business under the license or appointment. Section 626.611(9), Florida Statutes (1999). (e) Willful failure to comply with, or willful violation of, any proper order or rule of the Department or willful violation of any provision of this code. Section 626.611(13), Florida Statutes (1999), (f) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. Section 626.621(2), Florida Statutes (1999). 14 (g) Violation of the provision against twisting, as defined in s. 626.9541(1)(1). Section 626.621(5), Florida Statutes (1999). (h) 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 this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public or detrimental to the public interest. Section 626.621(6), Florida Statutes (1999). (i) If a life agent, violation of the code of ethics. Section 626.621(9), Florida Statutes (1999). qj) Knowingly making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which misrepresents the benefits, advantages, conditions, or terms of any insurance policy. Section 626.9541(1)(a), Florida Statutes (1999). (k) | Knowingly making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance, which is untrue, deceptive, or misleading. Section 626.9541(1)(b), Florida Statutes (1999). dl) 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), Florida Statutes (1999). (m) Knowingly making a false or fraudulent written or oral statemert or representation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual. Section 626.9541(1)(k), Florida Statutes (1999). (n) Knowingly making any misleading misrepresentations or incomplete or fraudulent comparisons or fraudulent material omissions of or with respect to any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance in another insurer. Section 626.9541(1)(1), Florida Statutes (1999). COUNT VI 30. The above general allegations are hereby realleged and fully incorporated herein by reference. 31. According to official Department records, Richard Gionfriddo was the primary agent of PFS up until May 6, 2002. On May 6, 2002, Richard Gionfriddo's status as primary agent was terminated. 32. According to official Department records, you, L. DAVID GILLUM, were not named as primary agent of PFS until September 3, 2002. 33. According to official Department records, there was no other primary agent for PFS known to or identified by the Department between May 6 and September 3, 2002. 34. You, L. DAVID GILLUM, operated PFS from May 6, 2002 through September 3, 2002 without a primary agent designated for that agency. IT IS THEREFORE CHARGED that you, L. DAVID GILLUM, 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 license and appointments: 16 (a) Each person operating an insurance agency and each location of a multiple location agency shall designate a primary agent for each insurance agency location and shall file the name of the person so designated, and the address of the insurance agency location where he or she is primary agent, with the Department, on a form approved by the department. The designation of the primary agent may be changed at the option of the agency, and any change shall be effective upon notifications to the department. Notice of change must be sent to the department within 30 days after such change. Section 626.592(1), Florida Statutes (2002). (b) An insurance agency location may not conduct the business of insurance unless a primary agent is designated at all times. Failure to designate a primary agent, on a form prescribed by the Department, within 30 days after agency inception or change of primary agent designation, constitutes grounds for requiring that the agency obtain a license in accordance with ss. 626.112 and 626.172. Section 626.592(7), Florida Statutes (2002). (c) Demonstrated lack of reasonably adequate knowledge and techaical competence to engage in the transactions authorized by the license or appointment. Section 626.611(8), Florida Statutes (2002). (d) Willful failure to comply with, or willful violation of, any proper order or rule of the Department or willful violation of any provision of this code. Section 626.611(13), Florida Statutes (2002). (e) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. Section 626.621(2), Florida Statutes (2002). WHEREFORE, you, L. DAVID GILLUM, are hereby notified that the Chief Financial Officer intends to enter an Order suspending or revoking your licenses and appointments as an 17 insurance agent or to impose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691, and 626.9521, Florida Statutes (2003), and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint. 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 (2003), 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 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 purpese of service: 18 (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 from 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 (2003), 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 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 (2003). 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 19 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 (2003), 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 and SIGNED this 2.5 4 day of October , 2004. boul Casale HANDLER Deputy Chief Financial Officer 20 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF RIGHTS has been furnished to: L. DAVID GILLUM, PFS- Property & Casualty, 827 Cypress Parkway, Kissimmee, FL 34759-3408; L. DAVID GILLUM, tons ino Oral 4050 Citrus Street, Kissimmee, Florida 34746-3704, by Certified Mail this _&© Stay of O ¢ Michael T. Ruff Florida Bar Number 688541 Division of Legal Services 612 Larson Building 200 East Gaines Street 2004. Tallahassee, Florida 32399-033 oa . Popp esncececeveeececceeeseeenesensecasnese. ne: Oo % 2 i 2. Article Numbop Tot ttreteeceesceeencneececece seen ees ALT AO()\T ‘ ~ COMPLETE THIS SECTION ON-DELIVERY:: ‘D A. Received by (Ploase Pring Siearlyy ° S, VD Opec A ro sed Sh SY Mik b D. IS delivery address different 175 ff YES, enter delivery address below ” TIM 7UbD 390% 9844 2699 2709 { 3. Service Type CERTIFIED MAIL { 4. Restricted Dolivery? (Extra Fee) | 1. Article Addressed to, eterence In L. DAVID GILIJUM PFS-PROPERTY & CASUALTY 827 CYPRESS PARKWAY KISSIMMEE, FL 34759-3408 68743-04-AG AC 10/25/2004" * Ruff ReStRiczens Deuver PS Form 381 1, July 2001 Domestic Return Receipt RESTRICTED Net iyery PS Form 381 1, July 2001 Domestic Retum Receipt AT sie STATE OF FLORIDA : DEPARTMENT OF FINANCIAL SERVICES ° DIVISION OF LEGAL SERVICES hangs u 04 GY 29 PH ls: 36 ia IN THE MATTER OF: eos de rt L. DAVID GILLUM CASE NO.: 68743:02: ELECTION OF PROCEEDING I have received and have read the Notice of the ADMINISTRATIVE COMPLAINT filed against me, including the Notice of Rights contained therein, and I understand my options. I am requesting disposition of this matter as indicated below. (Choose one) 1 [] I do not dispute any of the Department’s factual allegations and I do not desire a hearing. I understand that by waiving my right to a hearing, the Department may enter a final order that adopts the Administrative Complaint and imposes the sanctions sought, including revoking ray licenses and appointments as may be appropriate. 2. 1 do not dispute any of the Department's factual allegations and I hereby elect a proceeding to be conducted in accordance with Section 120.57(2), Florida Statutes (2003). In this regard, I desire to (Choose one): {] Submit a written statement and documentary evidence in lieu of a hearing; or [] Personally attend a hearing conducted by a department hearing officer in Tallahassee; or [] Attend that same hearing by way of a telephone conference call. 3. [J I do dispute one or more of the Department's factual allegations. I hereby request a hearing pursuant to Section 120.57(1), Florida Statutes (2003), to be held before the Division of Administrative Hearings, TO PRESERVE YOUR RIGHT TO A HEARING, YOU MUST FILE YOUR RESPONSE WITH THE DEPARTMENT OF FINANCIAL SERVICES WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT. THE RESPONSE MUST BE RECEIVED BY THE DEPARTMENT NO LATER THAN 5:00 P.M. ON THE TWENTY-FIRST DAY AFTER YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT. The address for filing is: General Counsel as acting agency clerk, Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. Signature Print Name Date: . Address: _ Phone No.: 22

Docket for Case No: 04-004299