THE TREASURER OF THE STATE OF FLORIDA JUL 28 2000 DEPARTMENT OF INSURANCE TREASURER SUC BILL NELSON INSURANCE © IN THE MATTER OF: O|-o4dsel ep CASE NO.: 34816-00-AG JACQUELINE D. GATES-LEWIS / scone coca Docketed + o Soe 3 ADMINISTRATIVE COMPLAINT oe mes 2 TT BIS ~. mw TO: JACQUELINE D. GATES-LEWIS Bee 5 as] 11535 N US Highway 301 O27 Oxford, FL 34484-3577 mo JACQUELINE D. GATES-LEWIS C/o Sheffield Insurance 20324 E Pennsylvania Ave Dunnellon, FL 34432-6031 You, JACQUELINE D. GATES-LEWIS. 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, JACQUELINE D. GATES- LEWIS, are currently licensed in this State as a health insurance agent and a general lines insurance agent. 2. At all times pertinent to the dates and occurrences referred to herein, you, JACQUELINE D. GATES-LEWIS, were licensed in this State as a health insurance agent and a general lines insurance agent. U U | 4 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, JACQUELINE D. GATES-LEWIS, were employed as an insurance agent at the Mid-Florida Insurance. Inc., in Ocala. Florida. COUNT I 5. The General Allegations set forth in Paragraphs | through 4 above are hereby realleged and fully incorporated herein by reference. 6. On or about December 14. 1998. a facsimile was sent to Bay Financial Savings Bank of an insurance binder for a homeowners insurance policy purporting to insure the personal residence of you, JACQUELINE D. GATES-LEWIS, located at 3520 SW 181° Court, Dunnellon, Florida. Said binder lists the effective date for the binder as December 18, 1998, and is signed by you, JACQUELINE D. GATES-LEWIS, as the authorized representative. 7. On or about December 28, 1998, a facsimile was sent to Bay Financial Savings Bank of a second insurance binder for a homeowners insurance policy purporting to insure the personal residence of you, JACQUELINE D. GATES-LEWIS, located at 3520 SW.181* Court, Dunnellon, Florida. Said binder lists the effective date for the binder as December 28, 1998, and is purportedly signed by Connie L. Goff, who worked as an insurance agent at Mid-Florida Insurance, Inc., at or about the time this binder was sent via facsimile to Bay Financial Savings Bank. 8. The signature of Connie L. Goff on the insurance binder referenced in Paragraph 7 above was a forgery. WU WU 9. You, JACQUELINE D. GATES-LEWIS. failed to forward an application for said homeowners insurance policy to any insurance company, and no homeowners insurance policy was issued by any insurance company in connection with the binder you sent to Bay Financial Savings Bank. 10. Asa result of receiving the binders and receipt referenced in Paragraphs 7 through 9 above. Bay Financial Savings Bank relied upon those documents as proof that you, JACQUELINE D. GATES-LEWIS, had obtained homeowners insurance on your personal residence located at 3520 SW 181° Court, Dunnellon. Florida. and. based thereon, authorized a loan to you, JACQUELINE D. GATES-LEWIS. 11. Upon notification that no homeowners insurance policy had been issued to cover your personal residence located at 3520 SW 181% Court, Dunnellon, Florida, Bay Financial Savings Bank force-placed insurance on the property. Additionally, Bay Financial Savings Bank sustained a loss of approximately $15,000.00 on the foreclosure sale of the Property. Had Bay Financial Savings Bank not made the loan to you, JACQUELINE D. GATES-LEWIS, based upon your representation that you had secured homeowners insurance on your personal residence located at 3520 SW 181* Court, Dunnellon. F lorida, Bay Financial Savings Bank would not have incurred the aforementioned losses. IT IS THEREFORE CHARGED that you, JACQUELINE D. GATES-LEWIS, 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, registrations, and appointments as an insurance agent: (a) Ifthe license or appointment is willfully used, or to be used, to circumvent any of the requirements or prohibitions of this code. {Section 626.61 1(4), Florida Statutes]; WU ww] (b) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.61 1(7), Florida Statutes]; (c) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), 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 626.61 1(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]; (f) 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 X 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]; and (g) Knowingly making, publishing, disseminating, circulating; delivering to any person; placing before the public; causing, directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public; any false material statement. [Section 626.9541(1)(e)1.b.c.d. and e.2., Florida Statutes). WHEREFORE, you, JACQUELINE D. GATES-LEWIS, are hereby notified that the Treasurer and Insurance Commissioner intends to enter an Order revoking your licenses, registrations, and appointments as an insurance agent or to impose such lesser 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 the Administrative Complaint. NOTICE OF RIGHTS Pursuant to Section 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 32399-0333. 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 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. ro) WY {f you dispute material facts which are the basis for this agency's action you may request a formal adversarial proceeding pursuant to Section 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 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 the 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. Pursuant to Section 120.573, Florida Statutes, you are hereby notified that mediation 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 notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. a WW UY DATED and SIGNED this 28TH day of _ JULY . 2000. ILL NELSON Treasurer and Insurance Commissioner wu Nw) CERTIFICATE OF SERVICE THEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been furnished to: JACQUELINE D. GATES-LEWIS. 11535 N US Highway 301. Oxford, FL 34484-3577; and JACQUELINE D. GATES-LEWIS. C/o Sheffield Insurance. 20324 E Pennsylvania Ave, Dunnellon. FL 34432-6031. by US. Certified Mail this 28THday of _ JULY , 2000. E227 rJ. fh. Florida Department of Insurance Division of Legal Services 200 East Gaines Street 612 Larson Building Tallahassee, FL 32399-0333 (850) 413-4250

Docket for Case No: 01-000448PL