FLORIDA DEPARTMENT OF FINANCIAL SERVICES TOM GALLAGHER CHIEF SINANCIAL OFFICER FILED STATE OF FLORIDA Za 7 AUG 30 2004; io IN THE MATTER OF: pocketed by; uM 8. CASE NO.: 70467-04-AG° ¥ \ ROBERT WILSON ALLEN ADMINISTRATIVE COMPLAINT TO: ROBERT WILSON ALLEN 4302 West Robin Lane Tampa, FL 33609 ROBERT WILSON ALLEN WILLIS OF FLORIDA 6200 COURTNEY CAMPBELL CSWy #300 Tampa, FL 33607 You, ROBERT WILSON ALLEN, license I.D. #A004215, are hereby notified that the Chief Financial Officer of the State of Florida has caused to be madc 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, ROBERT WILSON ALLEN, are currently licensed in this state as a General Lines (Property & Casualty) (2-20) Agent. 2. At all times material to the dates and occurrences referred to herein, you, ROBERT WILSON ALLEN, were licensed in this state as an insurance 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 or about August 6, 2002, you, ROBERT WILSON ALLEN, issued a certificate of liability insurance to Wood-Hopkins Contracting, LLC indicating that Wood- Hopkins Contracting, LLC had a valid workers’ compensation insurance policy with Zurich American Insurance Company. 6. At the time you, ROBERT WILSON ALLEN, issued said certificate of liability insurance, Zurich American Insurance Company had not issued a workers’ compensation insurance policy to Wood-Hopkins Contracting, LLC. 7. You, ROBERT WILSON ALLEN, issued the certificate referred to in paragraph five (5) herein without contacting Zurich American Insurance Company or its agent(s) to confirm the existence of coverage and without a good faith belief that Wood-Hopkins Contracting, LLC had a workers’ compensation insurance policy in force through Zurich American Insurance Company. The certificate issued by you, ROBERT WILSON ALLEN, had no basis in fact and was not valid. 8. You, ROBERT WILSON ALLEN, were not the agent of record for Wood- Hopkins Contracting, LLC, nor did you, ROBERT WILSON ALLEN, make any effort to establish yourself as the agent of record for the company. 9. At all times relevant hereto, Wood-Hopkins Contracting, LLC, as a Florida employer, was required to secure the payment of compensation for its employees pursuant to Sections 440.10(1).and 440.38(1), Florida Statutes. On November 5, 2002, the Department__ issued a Stop- Work Order against Wood-Hopkins Contracting, LLC, requiring the cessation of all business operations, to the detriment of Wood-Hopkins Contracting, LLC. IT IS THEREFORE CHARGED that you, ROBERT WILSON ALLEN, 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) 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]; (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, commission, or office or willful violation of any provision of this code. [Section 626.611(13), Florida Statutes]; (e) Knowingly making any false entry of a material fact in any book, report, or statement of any person, or knowingly omitting to make a true entry of any material fact pertaining to the business of such person in any book, report, or statement of such person. [Section 626.9541(1)(c)2., Florida Statutes]. WHEREFORE, you, ROBERT WILSON ALLEN, are hereby notified that the Chief ~-Financtal- 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, and 626.9521, 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 pursuant to Sections 120.569 and 120.57, Florida Statutes, 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 purpose of service; (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, 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 of Financial Services. DATED and SIGNED this 30% day of August. , 2004. KAREN CHANDLER Deputy Chief Financial Officer CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF PROCEEDING has been furnished to: ROBERT WILSON ALLEN, 12407 Plantation Pine Lane #302, Tampa, FL 33635; ROBERT WILSON ALLEN, WILLIS OF FLORIDA, 6200 COURTNEY CAMPBELL CSWY #300, Tampa, FL 33607 by Certified Mail this SOP ay of August. 2004, David D. Hershel / , / Division of Legal Services 200 East Gaines St. 612 Larson Building Tallahassee, Florida 32399-033 (850) 413-1686 Florida Bar Number 0841986 2. Article Number 7" COMPLETE THIS SECTION ON DELIVERY j Ps Form 387 1, duly 2001 i PS Form oe..,

Docket for Case No: 04-003428PL