FILED AUG 21 Ril THE TREASURER OF THE STATE OF FLORIDA DEPARTMENT OF INSURANCE BILL NELSON AGM “ibi Si esi IY VE HEARINGS O6° 3317 IN THE MATTER OF: RAFAEL RALPH GONZALEZ CASE NO.: 33189-99-AG / ADMINISTRATIVE COMPLAINT TO: RAFAEL RALPH GONZALEZ 15620 SW 53rd. Street Miami, Florida 33185-4142 You, RAFAEL RALPH GONZALEZ, are hereby notified that the Insurance Commissioner 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, RAFAEL RALPH GONZALEZ, are currently licensed in this state as a life, a life and health, and a health agent. 2. At all times pertinent to the date and occurrences referred to herein, you, RAFAEL RALPH GONZALEZ, were licensed as an insurance agent in this state. 3. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance has jurisdiction over your insurance licenses and appointments. 4. At all times pertinent to the dates and occurrences referred to herein, you, RAFAEL RALPH GONZALEZ, were the general agent of for Columbian Life Insurance Company. 5. You, RAFAEL RALPH GONZALEZ, established a premium trust account at Marine Midland Bank, that is a bank account, assigned number 348833857 into which you agreed to timely deposit these premium collections on behalf of the Columbian Life Insurance Company. Count I 6. The above general allegations are hereby realleged and fully incorporated herein by reference 7. During June of 1998, you, RAFAEL RALPH GONZALEZ, as a general agent for Columbian Life Insurance Company, prepared and filed a report with this Company of debit collections you received from insureds for the month of June of 1998, where you reported $1,966.93 in premium funds that you deposited to your special company bank account. Based upon these collections, you, RAFAEL RALPH GONZALEZ, owed this Insurer $1,966.93 in funds for < this month of June of 1998. nN YU YW 8. On or about July 31, 1998, the Company tried to process an electronic transfer draft of funds in the amount of $1,966.93, but the Bank dishonored that request and gave notification that there were not sufficient funds on hand in this bank account to honor and pay this electronic draft. 9. According to officials of Columbian Life Insurance Company, this Company then advised you by letter, dated August 12, 1998, that the draft had been dishonored and that the Company hereby demanded payment of these insurance premiums from you, RAFAEL RALPH GONZALEZ. 10. You, RAFAEL RALPH GONZALEZ, were unable to restore these premiums to the Columbian Life Insurance Company, until April 26, 1999. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department’ of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: (a) All premiums, return premiums, or other funds belonging to insurers or others received by an agent, solicitor, or adjuster in transactions under his license shall be trust funds so received by the licensee in a fiduciary capacity. An agent shall keep the w i LU ww) funds belonging to each insurer for which he is not appointed, other than a surplus lines insurer, in a separate account so as to allow the department to properly audit such funds. The licensee in the applicable regular course of business shall account for and pay the same to the insurer, insured, or other person entitled thereto. [Section 626.561(1), Florida Statutes] (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes] (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] (ad) Fraudulent or dishonest practices in the conduct of business under the license or appointment. {Section 626.611(9), Florida Statutes] (e) 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] (£) Willful failure to comply with, or willful violation of, any proper order or rule of the department or willful U UY violation of any provision of this code. [Section 626.611(13), 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] Count IT 11. The above general allegations are hereby realleged and fully incorporated herein by reference. 12. During August of 1998, you, RAFAEL RALPH GONZALEZ, as a general agent for Columbian Life Insurance Company, prepared and filed a report with this Company of debit collections you received from insureds for the month of July of 1998, where you reported $286.94 in premium funds that you deposited to your special company bank account. Based upon these collections, you, RAFAEL RALPH GONZALEZ, owed this Insurer $286.94 in funds for this month of August of 1998. 13. On or about September 13, 1998, the Company tried to process an electronic transfer draft of funds in the amount of $286.94, but the Bank dishonored that request and gave notification that there were not sufficient funds on hand in this bank account to honor and pay this electronic draft. GE i ww 1) 14. According to officials of Columbian Life Insurance Company, this Company then advised you by letter, dated October 13, 1998, that the draft had been dishonored and that the Company hereby demanded payment of these insurance premiums from you, RAFAEL RALPH GONZALEZ. 15. You, RAFAEL RALPH GONZALEZ, were unable to restore these premiums to the Columbian Life Insurance Company, until April 26, 1999. IT IS THEREFORE CHARGED -that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626 .611(23) ' and 626.621(2), Florida Statutes, which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. Count TIT 16. The above general allegations are hereby realleged and fully incorporated herein by reference 17. During September of 1998, you, RAFAEL RALPH GONZALEZ, as a general agent for Columbian Life Insurance Company, prepared YY WY and filed a report with this Company of debit collections you received from insureds for the month of July of 1998, where you reported $2,578.62 in premium funds that you deposited to your special company bank account. Based upon these collections, you, RAFAEL RALPH GONZALEZ, owed this Insurer $2,578.62 in funds for this month of September of 1998. 18. On or about October 30, 1998, the Company tried to process an electronic transfer draft of funds in the amount of $2,598.62, but the Bank dishonored that request and gave notification that there were not sufficient funds on hand in this bank account to honor and pay this electronic draft. 19. According to officials of Columbian Life Insurance Company, this Company then advised you by letter, dated November 13, 1998, that the draft had been dishonored and that the Company hereby demanded payment of these insurance premiums from you, RAFAEL RALPH GONZALEZ. ; . + 20. On February 1, 1999, the Columbian Life Insurance Company notified the Department that it terminated your appointments because these three monthly remittances (noted above) were returned for non-payment. 21. You, RAFAEL RALPH GONZALEZ, were unable to restore these premiums to the Columbian Life Insurance Company, until April 26, 1999. UY YW IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), and 626.621(2); Florida Statutes, which are set forth specifically in Count I above and are hereby realleged and fully incorporated herein by reference. COUNT IV 22. The above general allegations are hereby realleged and fully incorporated herein by reference. 23. Based upon an investigation conducted in 1999 by the Columbian Life Insurance Company, on or about January 31, 1998, you, RAFAEL RALPH GONZALEZ, did prepare and sign as witness and : agent of record, a policy form designed to request and initiate a complete dividend withdrawal in the amount of $91.87 on the whole life policy number 6700320406/1100630886 issued on your insured, Pearl Pace, of Miami, Florida, by the Columbian Life Insurance Company. 24. On or about February 23, 1998, the Columbian Life Insurance Company approved and processed this transaction and WU WU issued check number 772259 payable to Pearl Pace in the amount of $91.87. 25. You, RAFAEL RALPH GONZALEZ, did intercept this check and did negotiate this check for deposit into a bank account that you controlled. You then did misappropriate these funds which were intended for your insured, Pearl Pace. 26. According to an affidavit executed by Pearl Pace, Pearl Pace did not request a dividend withdrawal; nor did she initiate the dividend withdrawal form, nor did she sign her name to any such form; nor did she receive the above check; nor did she receive any of the policy dividend funds from you, RAFAEL RALPH GONZALEZ. 27. %It is alleged that you, RAFAEL RALPH GONZALEZ, did fraudulently prepare, witness, execute, and forward this false request for withdrawal of dividend form ostensibly on behalf of your insured, Pearl Pace. | 28. You, RAFAEL RALPH GONZALEZ, have misappropriated, converted or unlawfully withheld fiduciary funds, to wit: the dividend accumulations of your insured, Pearl. Pace, which were to be paid to her. 29. To date, you, RAFAEL RALPH GONZALEZ, have yet to restore these funds to the Columbian Life Insurance Company, who YU Nw] discovered this defalcation and restored these funds to your insured, Pearl Pace. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: (a) Failure or refusal, upon demand, to pay over to any insurer he or she represents or has represented any money coming into his or her hands belonging to the insurer. [Section 626.621(4), Florida Statutes] (b) 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 xX of 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] (c) False claims; obtaining or retaining money dishonestly.— 1. Any agent, physician, claimant, or other person who causes to be presented to any insurer a false claim for payment, knowing the same to be false; or U Nw 2. Any agent, solicitor, collector, or other person who represents any insurer or collects or does business without the authority of the insurer, secures cash advances by false statements, or fails to turn over when required, or satisfactorily account for, all collections of such insurer, shall, in addition to the other penalties provided in this act, be guilty of a misdemeanor of the second degree and, upon conviction thereof, shall be subject to the penalties provided by ss. 775.082 or ss. 775.083. [Section 626.9541(1) (u), Florida Statutes] (d) Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), and 626.621(2), Florida Statutes, which are set forth specifically in Count I above, are ' hereby realleged and fully incorporated herein by reference: COUNT _V 30. The above general allegations are hereby realleged and fully incorporated herein by reference. 31. Based upon an investigation conducted in 1999 by the Columbian Life Insurance Company, on or about June 23, 1994, you, RAFAEL RALPH GONZALEZ, did prepare and sign as witness and agent of record, a policy form designed to request and initiate a dividend withdrawal in the amount of $246.00 on the whole life UY Ne) policy number 6610153015 issued on your insured, Alton Jackson, of Miami, Florida, by the Columbian Life Insurance Company. 32. On or about July 5, 1994, the Columbian Life Insurance Company approved and processed this transaction and issued check number 429148 payable to Alton Jackson in the amount of $246.00. 33. You, RAFAEL RALPH GONZALEZ, did intercept this check and did negotiate this check for deposit into a bank account that you controlled. You then did misappropriate these funds which were intended for your insured, Alton Jackson. 34. According to an affidavit executed by Alton Jackson, Alton Jackson did not request a withdrawal of dividend; nor did he initiate the withdrawal of dividend form, nor did he sign his name to any such form; nor did he receive the above check; nor did he receive any of the withdrawal of dividend funds from you, RAFAEL RALPH GONZALEZ. 35. It is alleged that you, RAFAEL RALPH GONZALEZ, ‘did fraudulently prepare, witness, execute, and forward this false request for withdrawal of dividend form ostensibly on behalf of your insured, Alton Jackson. 36. You, RAFAEL RALPH GONZALEZ, have misappropriated, converted or unlawfully withheld fiduciary funds, to wit: the withdrawal of dividend proceeds of your insured, Alton Jackson, which were to be paid to him. YW ] 37. To date, you, RAFAEL RALPH GONZALEZ, have yet to restore these funds to the Columbian Life Insurance Company, who discovered this defalcation and restored these funds to your insured, Alton Jackson. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), 626.621(2), 626.621(4), 626.621(6), and 626.9541(1) (u), Florida Statutes, which are set forth specifically in Count’s I and IV above and are hereby realleged and fully incorporated herein by reference. “count VI 38. The above general allegations are hereby realleged and fully incorporated herein by reference. 39. Based upon an investigation conducted in 1999 by the Columbian Life Insurance Company, on or about June 17, 1998, you, RAFAEL RALPH GONZALEZ, did prepare and sign as witness and agent of record, a policy form designed to request and initiate a dividend withdrawal in the amount of $746.37 on the whole life 13 YW YW policy number 6800595764 issued on your insured, Ronald Johnson, of Miami, Florida, by the Columbian Life Insurance Company. 40. On or about June 30, 1998, the Columbian Life Insurance Company approved and processed this transaction and issued check number 113813 payable to Ronald Johnson in the amount of $746.37. 41. You, RAFAEL RALPH GONZALEZ, did intercept this check and did negotiate this check for deposit into a bank account that you controlled. You then did misappropriate these funds which were intended for your insured, Ronald Johnson. 42. According to an affidavit executed by Ronald Johnson, Ronald Johnson did not request a dividend withdrawal; nor did he initiate the dividend withdrawal form, nor did he sign his name to any such form; nor did he receive the above check; nor did he receive any of the dividend withdrawal funds from you, RAFAEL RALPH GONZALEZ. 43. It is alleged that you, RAFAEL RALPH GONZALEZ, ‘did fraudulently prepare, witness, execute, and forward this false request for withdrawal of dividend form ostensibly on behalf of your insured, Ronald Johnson. 44. You, RAFAEL RALPH GONZALEZ, have misappropriated, converted or unlawfully withheld fiduciary funds, to wit: the policy withdrawal of dividend proceeds of your insured, Ronald Johnson, which were to be paid to him.. 14 U Nw 45. To date, you, RAFAEL RALPH GONZALEZ, have yet to restore these funds to the Columbian Life Insurance Company, who discovered this defalcation and restored these funds to your insured, Ronald Johnson. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), 626.621(2), 626.621(4), 626.621(6) and 626.9541(1) (u), Florida Statutes, which are set forth specifically in Counts I and IV above and are hereby realleged and fully incorporated herein by reference. COUNT VIT 46. The above general allegations are hereby realleged and fully incorporated herein by reference. 47. Based upon an investigation conducted in 1999 by the Columbian Life Insurance Company, on or about April 17, 1994, you, RAFAEL RALPH GONZALEZ, did prepare and sign as witness and agent of record, a policy form designed to request and initiate a dividend withdrawal-in the. amount of $237.82 on the whole life 15 WU UY policy number 6800384006 issued on your insured, King D. Black, of Miami, Florida, by the Columbian Life Insurance Company. 48. On or about April 21, 1994, the Columbian Life Insurance Company approved and processed this transaction and issued check number 407739 payable to King D. Black in the amount of $237.82. 49. You, RAFAEL RALPH GONZALEZ, did intercept this check and did negotiate this check for deposit into a bank account that: you controlled. “You then did misappropriate these funds which were intended for your insured, King D. Black. 50. According to an affidavit executed by King D. Black, Mr. Black did not request a dividend withdrawal; nor did he initiate the dividend withdrawal form, nor did he sign his name to any such form; nor did he receive the above check; nor did he receive any of the dividend withdrawal funds from you, RAFAEL RALPH GONZALEZ. S51. It is alleged that you, RAFAEL. RALPH GONZALEZ, did fraudulently prepare, witness, execute, and forward this false request for withdrawal of dividend form ostensibly on behalf of your insured, King D. Black. 52. You, RAFAEL RALPH GONZALEZ, have misappropriated, converted or unlawfully withheld fiduciary funds, to wit: the U YU policy withdrawal of dividend proceeds of your insured, King D. Black, which were to be paid to him. 53. To date, you, RAFAEL RALPH GONZALEZ, have yet to restore these funds to the Columbian Life Insurance Company, who discovered this defalcation and restored these funds to your insured, King D. Black. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), 626.621(2), 626.621(4), 626.621(6), and 626.9541 (1) (u), Florida Statutes, which are set forth specifically in Counts I and IV above and are hereby realleged and fully incorporated herein by reference. COUNT VIII 54. The above general allegations are hereby realleged and fully incorporated herein by reference. 55. Based upon an investigation conducted in 1999 by the Columbian Life Insurance Company, on or about November 29, 1995, you, RAFAEL RALPH GONZALEZ, did prepare and sign as witness and 17 YU Nw) agent of record, a policy form designed to request and initiate both a policy loan and a dividend withdrawal in the aggregate amount of $918.92 on the whole life policy number 6800411322 issued on your insured, Mary J. Allen, of Miami, Florida, by the Columbian Life Insurance Company. 56. On or about January 5, 1996, the Columbian Life Insurance Company approved and processed this transaction and issued check number 569036 payable to Mary J. Allen in the amount of $918.92. 57. You, RAFAEL RALPH GONZALEZ, did intercept this check and did negotiate this check for deposit into a bank account that you controlled. You then did misappropriate these funds which were intended for your insured, Mary J. Allen. 58. According to an affidavit executed by Mary J. Allen, Ms. Allen did not request a loan/dividend withdrawal; nor did she initiate the dividend withdrawal form, nor did she sign her name to any such form; nor did she receive the above check; nor did she receive any of the loan/dividend withdrawal funds from you, RAFAEL RALPH GONZALEZ. 59. It is alleged that you, RAFAEL RALPH GONZALEZ, did fraudulently prepare, witness, execute, and forward this false request for withdrawal of dividend form ostensibly on behalf of your insured, Mary J. Allen. UY Nw] 60. You, RAFAEL RALPH GONZALEZ, have misappropriated, converted or unlawfully withheld fiduciary funds, to wit: the policy loan and withdrawal of dividend proceeds of your insured, Mary J. Allen, which were to be paid to her. 61. To date, you, RAFAEL RALPH GONZALEZ, have yet to restore these funds to the Columbian Life Insurance Company, who discovered this defalcation and restored these funds to your insured, Mary J. Allen. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), 626.621(2), 626.621(4), 626.621 (6), and 626.9541(1) (u), Florida Statutes, which are set forth specifically in Counts I and IV above and are hereby realleged and fully incorporated herein by reference. COUNT IX 62. The above general allegations are hereby realleged and fully incorporated herein by reference. WU 7] 63. Based upon an investigation conducted in 1999 by the Columbian Life Insurance Company, on or about December 2, 1993, you, RAFAEL RALPH GONZALEZ, did prepare and sign as witness and agent of record, a policy form designed to request and initiate a dividend withdrawal in the amount of $404.82 on the whole life policy number 6700291278 issued on your insured, George E. Hopkins, of Miami, Florida, by the Columbian Life Insurance Company. 64. On or about January 24, 1994, the Columbian Life Insurance Company approved and processed this transaction and issued check number 382619 payable to George E. Hopkins in the amount of $404.82. 65. You, RAFAEL RALPH GONZALEZ, did intercept this check and did negotiate this check for deposit into a bank account that you controlled. You then did misappropriate these funds which were intended for your insured, George E. Hopkins. 66. According to an affidavit executed by George E. Hopkins, Mr. Hopkins did not request a dividend withdrawal; nor did he initiate the dividend withdrawal form, nor did he sign his name to any such form; nor did he receive the above check; nor did he receive any of the dividend withdrawal funds from you, RAFAEL RALPH GONZALEZ. WU WY 67. It is alleged that you, RAFAEL RALPH GONZALEZ, did fraudulently prepare, witness, execute, and forward this false request for withdrawal of dividend form ostensibly on behalf of your insured, George E. Hopkins. 68. You, RAFAEL RALPH GONZALEZ, have misappropriated, converted or unlawfully withheld fiduciary funds, to wit: the policy withdrawal of dividend proceeds of your insured, George E. Hopkins, which were to be paid to him. 69. To date, you, RAFAEL RALPH GONZALEZ, have yet to restore these funds to the Columbian Life Insurance Company, who discovered this defalcation and restored these funds to your insured, George E. Hopkins. IT IS THEREFORE CHARGED that you, RAFAEL RALPH GONZALEZ, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your licenses and appointments as an insurance agent: Sections 626.561(1), 626.611(7), 626.611(8), 626.611(9), 626.611(10), 626.611(13), 626.621(2), 626.621(4), 626.621(6), and 626.9541(1) (u), Florida Statutes, which are set forth specifically in Counts I and IV above and are hereby ~realleged and fully incorporated herein by reference. 21 U Nw WHEREFORE, you, RAFAEL RALPH GONZALEZ, aré hereby notified that the Treasurer and Insurance Commissioner 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, and 626.9521, Florida Statutes, and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint. 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 ether licenses and eligibility held by you under the Florida Insurance Code. NOTICE OF RIGHTS Pursuant to Sections 120.569 and 120.57, Florida Statutes and Rule 28-106, Florida Administrative Code (F.A.C.), you have the right to request a proceeding to contest this action by the Department. You may elect a proceeding by completing the attached Election of Rights form or filing a Petition. Your Petition or Election of a proceeding must be in writing and must be filed with the General Counsel acting as the Agency Clerk, Department of Insurance. If served by U.S. Mail the Petition or Election should be addressed to the Florida Department of Insurance at 612 Larson Building, Tallahassee, Florida 32399- _ 22 U Nw) 0333. If Express Mail or hand delivery is utilized, the Petition or Election should be delivered to 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. The Petition or Election must be received by, and filed in the Department within twenty-one (21) days of the date of your receipt of this notice. YOUR FAILURE TO RESPOND TO THIS ADMINISTRATIVE COMPLAINT WITHIN TWENTY- ONE (21) DAYS 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 a proceeding is requested and there is no dispute of fact, then the provisions of Section 120.57(2), Florida Statutes would apply. In this regard you may submit oral or written evidence in opposition to the action taken by this agency or a written statement challenging the grounds upon which the agency 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. If you dispute material facts which are the basis for this agency's action, you may request a formal adversarial proceeding pursuant to Sections 120.569 and 120.57(1), Florida Statutes. If you request this type of proceeding, the request must comply with all of the requirements of Rule 28-106, F.A.C. and contain: 23 U Nw] a) A statement identifying with particularity the allegations of the Department which you dispute and the nature of the dispute; b) An explanation of what relief you are seeking and believe you are entitled to; c) Any other information which you contend is material. 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. If you request a hearing, you have the right to be represented by counsel, or other qualified representative, to take testimony, to call and cross-examine witnesses, and to have subpoena and subpoena duces tecum issued on your behalf. You are hereby notified that mediation under Section 120.573, Florida Statutes, is not available. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All ‘prior correspondence in this matter shall be considered freeform agency action, and no such correspondence shall operate as a valid request for an administrative proceeding. Any request for administrative proceeding received prior to the date of this 24 ty UO 7. notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. DATED and SIGNED this 2f day of Ash ' By Wher BILL NELSON Treasurer and Insurance Commissioner CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been furnished to: - RAFAEL RALPH GONZALEZ; 15620 SW 53rd. Street; Miami, Flox 33185-4142, by Certified Mail this 2( day of 2000. >» J plod) 7, Z ROBERT F. LANGFORD, OR. Division of Legal Services 612 Larson Building . Tallahassee, FL 32399-0333 (850) 413-4138 Attorney for the Department 25

Docket for Case No: 00-003817PL