Son we FILED ALEX SINK OCT 28 2008 CHIEF FINANCIAL OFFICER STATE OF FLORIDA IN THE MATTER OF: CASE NO.: 90214-07-AG DONNIE E. BULLOCK ; / ADMINISTRATIVE COMPLAINT TO: DONNIE E. BULLOCK 406 South Ohio Avenue Live Oak, Florida 32064 DONNIE E. BULLOCK 10216 129™ Road Live Oak, Florida 32060 You, DONNIE E. BULLOCK, 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 and as a result of which it is alleged: GENERAL ALLEGATIONS 1. Pursuant to Chapter 626, Florida Statutes, you, DONNIE E. BULLOCK, currently are licensed in this state as a general lines agent, health insurance agent, life agent, and life and health agent, and were so licensed at all times relevant to the dates and occurrences referenced herein. Your license identification number is 4034893. 2. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Financial Services (“Department”) has jurisdiction over your license and appointments. 3. At all times relevant to the dates and occurrences referenced herein you, DONNIE E. BULLOCK, were manager, owner, and agent in charge of Bullock and Associates, LLC. 4. At all times relevant to the dates and occurrences referenced herein you, DONNIE E. BULLOCK, had the authority to execute checks on behalf of Bullock and Associates, LLC, Insurance Agency, and were the only person authorized to sign on the agency bank account. 5. At all times relevant to the dates and occurrence referenced herein, you, DONNIE E. BULLOCK, were an employee of, and agent for, Southern Homes Insurance Agency, Inc. 6. Pursuant to Chapter 626.561(1), Florida Statutes, all premiums, return premiums, or other funds belonging to insurers or others received by you, DONNIE E. BULLOCK, in transactions under your license are trust funds received in a fiduciary capacity. COUNT I 7. The above General Allegations are hereby realleged and fully incorporated herein by reference. 8. In or around May, 2006, Paul and Dorothy Chauncey went to Bullock and Associates, LLC, located at 406 South Ohio Avenue, Live Oak, Florida 32064, to purchase workers’ compensation insurance for SETCO Enterprises, Inc. (“SETCO”), and P.B.C., Inc. (“P.B.C.”). 9. At that time and place, Dorothy Chauncey gave you, .and you accepted, four thousand, eight hundred ten dollars ($4,810.00) by check as a down payment for the workers’ compensation insurance premium on SETCO Enterprises, Inc. 10. At that time and place, Dorothy Chauncey also gave you, and you accepted, five thousand dollars ($5,000.00) by check as a down payment for the workers’ compensation insurance premium on P.B.C., Inc. This check was deposited into your bank account in the name of Bullock & Associates, LLC. 11. You, DONNIE E. BULLOCK, completed both insurance applications for SETCO and P.B.C. 12. Dorothy Chauncey signed both sets of applications for workers’ compensation insurance. 13. You, DONNIE E. BULLOCK, did not give the Chaunceys copies of the applications for workers’ compensation insurance, copies of a premium finance agreement, or the name of the insurer. You did, however, tell the Chaunceys that they were covered “as of that moment.” 14. On or about August 1, 2006, and at the request of the Chaunceys, you, DONNIE E. BULLOCK, issued a Certificate of Liability Insurance to Gold Kist Poultry indicating that P.B.C. had workers’ compensation insurance coverage in place with Zurich Insurance Company as the provider. 15. Zurich Insurance Company has never provided coverage for P.B.C. and the policy number on the Certificate of Liability Insurance is inconsistent with the Zurich policy numbering system. 16. | On or about September 11, 2006, an employee of P.B.C. fell off of a ladder while working for P.B.C. He was taken to the hospital and suffered a punctured lung. 17. On or about October 12, 2006, the Chaunceys went to your office at which time you, DONNIE E. BULLOCK, informed them that their businesses did not have workers’ compensation insurance. 18. You, DONNIE E. BULLOCK, never forwarded the Chauncey’s payment and application for insurance to the insurer. 19. Mr. and Mrs. Chauncey never received the insurance coverage that they paid you, DONNIE E. BULLOCK, to secure. IT IS THEREFORE CHARGED that you, DONNIE E. BULLOCK, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code, which constitutes grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) All premiums, return premiums, or other funds belonging to insurers or others received by an agent, insurance agency, customer representative, or adjuster in transactions under the license are trust funds received by the licensee in a fiduciary capacity. An agent or insurance agency shall keep the funds belonging to each insurer for which an agent is not appointed, other than a surplus lines insurer, in a separate account so as to allow the department or office to properly audit such funds. The licensee in the applicable regular course of business shail account for and pay the same to the insurer, insured, or other person entitled thereto.[ Section 626.561(1), Florida Statutes]; . (b) 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]; () Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.61 1(7), Florida Statutes]; (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] (e) Fraudulent or dishonest practices. in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes]; f) Misappropriation, conversion, or unlawful withholding of moneys belonging to insurers or insureds or beneficiaries or to others and received in conduct of business under the license or appointment. [Section 626.611(10), Florida Statutes]; (g) 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]; (h) Violation of any lawful order or rule of the department, commission, or office. [Section 626.621(3), Florida Statutes]; (i) In the conduct of business under the license or appointment, engaging in unfair methods of competition or in unfair or deceptive acts or practices, as prohibited under part IX of this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public. [Section 626.621(6), Florida Statutes}; q) Misrepresents the benefits, advantages, conditions, or terms of any insurance policy. [Section 626.9541(1)(a)1, Florida Statutes]; (k) Delivering to any person any false material statement. [Section 626.9541(1)(e)c, Florida Statutes]; (9) 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)1, Florida Statutes]; (m) Knowingly collecting any sum as a premium or charge for insurance, which is not then provided, or is not in due course to be provided, subject to acceptance of the risk by the insurer, by an insurance policy issued by an insurer as permitted by this code. [Section 626.9541(1)(0)1, Florida Statutes] COUNT IT 20. | The above General Allegations are hereby realleged and fully incorporated herein by reference. 21. Onor about August 3, 2005, Adrienne Karst went to Southern Homes Insurance Agency to purchase liability insurance on her business named The Dance Shop. 22. At that time and place, Adrienne Karst was sold liability insurance for The Dance Shop by you, DONNIE E. BULLOCK. 23. At that time and place, Adrienne Karst made a down payment for the insurance premium in the amount of five hundred ninety-four dollars ($594) to you, DONNIE E. BULLOCK. The liability insurance policy was to be issued by Century Surety Company through Bass Underwriters. 24. At that time and place, Adrienne Karst entered into a premium finance agreement with Prime Rate Premium Finance Corporation, Inc. 25. You, DONNIE E. BULLOCK, issued a binder to Adrienne Karst indicating policy number CCP365871 for Century Surety Company. 26. You, DONNIE E. BULLOCK, never forwarded Adrienne Karst’s payment to the premium finance company, nor did you forward the application for insurance to the insurer. 27. Adrienne Karst sent premium payments by check to Prime Rate Premium Finance Corporation, Inc., but the checks were sent back to her indicating that no coverage was in place. When consumer Karst informed you of the returned premium payments, you, DONNIE E. BULLOCK, told her you would “take care of it” and assured her she had liability coverage. 28. In May, 2006, and at the request of Adrienne Karst, you, DONNIE E. BULLOCK, issued a Certificate of Liability Insurance to Suwannee County High School indicating that The Dance Shop had liability coverage in place with Burlington Insurance Company as the provider. 29. Burlington Insurance Company has never provided coverage for The Dance Shop and the policy number on the Certificate of Liability Insurance is inconsistent with the Burlington policy numbering system. 30. Adrienne Karst never received the coverage she paid you, DONNIE E. BULLOCK, to secure for her business. IT IS THEREFORE CHARGED that you, DONNIE E. BULLOCK, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code, which constitutes grounds for the suspension or revocation of your licenses as an insurance agent in this state: Sections 626.561(1), 626.611(5), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.621(2), 626.621(3), and 626.9541(1), Florida Statutes, which are more fully set forth in Count I above and fully incorporated herein by reference. COUNT Hl 31. | The above General Allegations are hereby realleged and fully incorporated herein by reference. 32. In 2005 and 2006, you, DONNIE E. BULLOCK, issued certificates of liability insurance to Frier Home Sales to cover the business’s dealership lots for those years. 33. An audit later revealed that no policies were in force during those years. 34. You knew or should have known that liability insurance coverages for Frier Homes Sales did not exist. | IT IS THEREFORE CHARGED that you, DONNIE E. BULLOCK, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code, which constitutes grounds for the suspension or revocation of your licenses as an insurance agent in this state: Sections 626.611(5), 626.611(7), 626.611(8), 626.611(9), 626.621(2), 626.621(3), and 626.9541(1), Florida Statutes, which are more fully set forth in Count I above and fully incorporated herein by reference. /COUNTIV 35. The above General Allegations are hereby realleged and fully incorporated herein by reference. 36. In or around October, 2006, you, DONNIE E. BULLOCK, submitted your resignation from Southern Homes Insurance Agency, Inc. 37. An investigation conducted by the Suwannee County Sheriff’s Office revealed that you, DONNIE E. BULLOCK, had deposited two hundred sixty-nine thousand, five hundred twenty-six dollars ($269,526) worth of premium checks made payable to Southern Homes Insurance Agency ‘into the account of Bullock Insurance Agency (account #03347853-01) without the knowledge of Southern Homes Insurance Agency. 38. You, DONNIE E. BULLOCK, were, at all times pertinent to these allegations, the owner of the Bullock Insurance Agency bank account (#03347853-01) and are the only signatory on the account. IT IS THEREFORE CHARGED that you, DONNIE E. BULLOCK, have violated or are accountable under one or more of the following provisions of the Florida Insurance Code, which constitutes grounds for the suspension or revocation of your licenses as an insurance agent in this state: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.621(2), and 626.621(3) Florida Statutes, which are more fully set forth in Count I above and fully incorporated herein by reference. WHEREFORE, you, DONNIE E. BULLOCK, are hereby notified that the Chief Financial Officer intends to enter an Order suspending or revoking your licenses and appointments as an insurance agent, or to impose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691, 626.692, and 626.9521, Florida Statutes, and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint and under the provisions of Rule 69B-231, Florida Administrative Code. You are further notified that any order entered in this case revoking or suspending any license or eligibility for licensure held by you shall also apply to all other licenses and eligibility held by you under the Florida Insurance Code. NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Department of Financial Services ("Department") pursuant to Sections 120.569 and 120.57, Florida Statutes, and Rule 28-106, 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 acting as 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 SUSPENSION OR REVOCATION WILL BE ENTERED AGAINST YOU. If you request a proceeding, you must provide information that complies with the requirements of Rule 28-106.2015, 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, address, and telephone number, and facsimile number (if any) of the respondent (for the purpose of requesting a hearing in this matter, you are the "respondent"). (b) The name, address, telephone number, facsimile number of the attorney or qualified representative of the respondent (if any) upon whom service of pleadings and other papers shall be made. (c) A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. (d) A statement of when the respondent received notice of the administrative complaint. 10 (e) A statement including the file number to the administrative complaint. 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 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. TAMMY TRATON Deputy Chief Financial Officer 12 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF PROCEEDING has been furnished to: DONNIE E. BULLOCK. 406 South Ohio Avenue Live Oak, Florida 32064 DONNIE E. BULLOCK 10216 1297 Road Live Oak, Florida 32060 if by Certified Mail this De Say of Letobh , 2008. A-\ 300 East Gaines St. 612 Larson Building Tallahassee, Florida 32399-033 (850) 413-4210 13

Docket for Case No: 08-006222PL