REPRESENTING ALEX SINK CHIEF FINANCIAL OFFICER STATE OF FLORIDA ae, a IN THE MATTER OF: OY 4) (OPEL CASE NO:: SHANTI J. PENA / ADMINISTRATIVE COMPLAINT TO: SHANTI J. PENA 2475 Aloma Avenue Winter Park, FL 32792 SHANTI J. PENA 16221 Old Ash Loop Orlando, FL 32828 You, SHANTI J. PENA, license I.D. #4021353, 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, you, SHANTI J. PENA, are currently licensed in this state as a general lines agent. 2. At all times pertinent to the dates and occurrences referred to herein, you, SHANTI J. PENA, were licensed in this state as a general lines agent. 3. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Financial Services (“Department”) has jurisdiction over your insurance licenses and appointments. COUNT I ; 4. The above general allegations are hereby realleged and fully incorporated herein by reference. 5. On June 23, 2005, while working at J. Meyers Insurance Group, you, SHANTI J. PENA, collected $1,027.00 from consumer Diana Cooper but forwarded only $513.00 to the insurer on July 15, 2005, the last day of your employment with the agency. 6. You, SHANTI J. PENA, did not remit the remaining funds to the insurer and J. Meyers Insurance Group was forced to pay the outstanding amount to keep the consumer’s policy in-force. IT IS THEREFORE CHARGED that you, SHANTI J. PENA, 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 licenses and appointments: (a) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (b) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes]; (c) Misappropriated, converted or unlawfully withheld money belonging to insurers, insured, or beneficiaries. [Section 626.611(10), Florida Statutes]. COUNT II 7. The above general allegations are hereby realleged and fully incorporated herein by reference. 8. On January 25, 2007, the Department conducted an agency inspection at Creative Insurance Underwriters, Inc., and found that you, SHANTI J. PENA, while working at that agency, were underwriting coverage requests, quotes, binds and rewriting policies without a company appointment. IT IS THEREFORE CHARGED that you, SHANTI J. PENA, 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 licenses and appointments: (a) Acted as or held herself out to be an insurance agent without being currently licensed by the department and appointed by an appropriate appointing entity or person. [Section 626.112(1)(a)1., Florida Statutes]; (b) Transacted or attempted to transact under her license any line of insurance for which she does not have in force of record with the Department an appointment by an authorized insurer. [Section 626.311(4), Florida Statutes]; (c) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.61 1(7), Florida Statutes]; (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]; (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]; WHEREFORE, you, SHANTI J. PENA, 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 626.561, 626.611, 626.681 and 626.691, Florida Statutes, 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 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"). (bv) 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) | Astatement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. (4) A statement of when the respondent received notice of the administrative complaint. (ec) _ Astatement 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. DATED and SIGNED this (“day of Quipher., 2008. Drerermey hago TAMMY TESTON Deputy Chief Financial Officer 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: SHANTI J. PENA, 2475 Aloma Avenue, Winter Park, FL 32792; SHANTI J. PENA, 16221 Old Ash Loop, Orlando, FL 32828 by Certified Mail this ‘day of Ocstobce? , 2008. Robert Alan Fox Senior Attorney Department of Financial Services Division of Legal Services 612 Larson Building 200 East Gaines St. Tallahassee, Florida 32399-033 (850) 413-4227

Docket for Case No: 09-005852PL