Mar 19 2008 9:15 DEPT OF FINANCIAL SERVICES FAs NO. : 8564874987 Mar. 19 2688 @8:22AM Pil4-sa REPRESENTING ALEX SINK FEB 14 2006 CHIEF FINANCIAL. OFFICER oaks ing_f ee , ca n STATE OF FLORIDA IN THE MATTER OF: CASE NO.: 89801-07-AG EDWARD MICHAEL RUMP ADMINISTRATIVE COMPLAINT EDWARD MICHALL RUMP 12437 SW 1" Street Coral Springs, Florida 33071 You, EDWART) MICHAEL RUMEP, license 1D. #A228285, 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 a public adjuster in this state, as a result of which it is alleged: GENERAL ALLEGATIONS 1. Pursuant to Chapter 626, Florida Statutes, you, EDWARD MICHAEL RUMP, are currently licensed in this state as a public adjuster. 2, At all limes pertinent to the dates and occurrences referred to herein, you, EDWARD MICHALL RUMP, were licensed in this state as a public adjuster. 3. Atall times material hereto, you, EDWARD MICHAEL RUMP, were the president of Continental Public Adjusters, Inc. (“Continental”). 4. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Financial Services (“Department”) has jurisdiction over your public adjuster license and appointments. Mar 19 2008 9:15 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:23AM P1538 COUNT] 5. The above general allegations are hereby realleged and fully incorporated herein by reference, 6. On July 19, 2003, A.G., of Hollywood, Florida, entered into a contract with Continental regarding a claim for water damage. 7. On or around November 11, 2003, you, EDWARD MICHAEL RUMP, and Continental sent G.A. a Settlement Statement. 8.‘ The Settlement Statement stated, in perlincnt part: “Per your request, enclosed is the insurance settlement check for you to endorse. Please sign and return the check. in envelope enclosed. Upon receipt of endorsed check, the Escrow check can be deposited. Continental Public Adjusters will continue to pursue additional monies owed for this claim. The claim settlement received from the Insurance Center does not indicate nor does il represent a full and final settlement for loss.” 9, The amount of the check was $3,952.73. 10. The $3,942.73 check represented a full and final settlement for loss. 11. You, EDWARD MICHAEL RUMP, knew, or should have known, that the $3,952.73 check represented a full and final settlement for loss. IT TS THEREFORE CHARGED that you, EDWARD MICHAEL RUMP, 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 fiiness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes |; (b) 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); Mar 19 2008 9:16 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:23AM Pi6-s8 (c) In the conduct of business under the license or appointment, engaging m unfair methods of competition or in unfair or deceptive acts or practices as prohibited under part TX of Chapter 626. [Section 626.621 (6), Florida Statutes]; (d) False statements and entries.-~ 1. Knowingly: b. Making, publishing, disseminating, circulating, c. Delivering lo any person, d. Placing before the public, e. 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)(c), florida Statutes]. COUNT Il 12, The above general allegations are hereby realleged and fully incorporated herein by reference. 13. ‘On September 17, 2004, D.C., of Boca Raton, Florida, entered into a contract with Continental regarding a claim for water damage. 14. After entering into ihe contract with D.C., you, EDWARD MICHAEL RUMP, and Continental did not work on D.C.’s claim. 15. You, EDWARD MICIIAET. RUMP, knew, or should have known, that you, EDWARD MICHAEL RUMP, and Continental did not work on D.C,’s claim. 16. You, EDWARD MICHAEL RUMP, and Continental, chose to work on hurricane related claims rather than on 1.C.’s claim. 17. After receiving a copy of D.C."s insurance policy, you, EDWARD MICHAEL RUMP, and Continental determined that D.C. had insufficient coverage for the damages he sustained to his property. Mar 19 2008 9:16 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + 85845749? Mar. 19 26688 @8:23AM Pi?/se 18. Contrary to your conclusion, D.C.’s insurance policy provided sufficient coverage for the damages he sustained to his property. 19. Ultimately, you, EDWARD MICHAEL RUMP, and Continental released D.C. from the contract. 20. D.C. was forced to find another adjuster, at a higher cost to D.C. IT IS THERRFORE CHARGED that you, EDWARD MICHAFI. RUMP, 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 appomtments: (a) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes], (b) 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 |; (c) Violation of any provision of this Code or any law applicable to the business of insurance in the course of dealing under the licensure or appointment. [Section 626.621(2), Florida Statutes]; (d) An adjuster shall subscribe to the code of ethics specitied in the rules of the department. The rules shall implement the provisions of this part and specify the terms and conditions of contracts, including a right to ‘cancel, and require practices necessary to ensure fair dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims [Section 626.878, Florida Statutes]; (¢) In the conduct of business under the license or appointment, having otherwise shown himself or herself to be a source of injury or loss to the public. [Section 626.621 (6), Florida Statutes |; (ft) Violation of any lawful order or rule of the department, commission, or office. |Section 626.621(3), Florida Statutes]; Mar 19 2008 9:16 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:24AM P1s-3a (@) Violating any provision of this chapter or a rule or order of the department. [Section 626.8698( 1), Florida Statutes] (h) Violating any ethical rule of the Department. [Section 626.8698(6), Florida Statutes |; G) An adjuster shall treat all claimants equally. [Rule 69B-220.201(3)(b), Fla, Admin. Code]; ¢ (Gj) An adjuster shal! not provide favored treatment to any claimant. [Rule 693- 220.201(3)(b)(1), Fla. Admin, Code]; (k) An adjuster shall adjust ali claims strictly in accordance with the insurance contract. [Rule 69B-220.201(3\b)\(2), Pla. Admin. Code]; () An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation. [Rule 69B-220,201(3)(d), Fla. Admin. Code]; (m) An adjuster shall handle every adjustment and settlement with honesty and integrity. [Rule 69B-220,201(3\(e), Fla, Admin. Code]; (0) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a-proper disposition of the claim. [Rule 69B-220,201(3)((), Fla. Admin, Code]. COUNT TIT 21. The above general allegations are hereby realleged and fully incorporated herein by reference. 22, After Hurricane Wilma, W.B., of Coral Springs, Florida, found an advertisement for public adjuster services from Continental in her mail box. 23. W.B. of Coral Springs, T'lorida, called Continental and requested Continental to send a public adjuster to her home. 24. On January 2, 2006, Roy ‘Trevino met with W.B. at her home. Mar 19 2008 9:17 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + 85845749? Mar. 19 2688 @8:24AM P1i9/se 25. — Louann Trevino was with Roy Trevino when he met with W.B. at her home on January 2, 2006. 26. Roy Trevino is Louann Trevino’s husband. 27. Roy Trevino told W.B. that he was sent by Continental. 28. Roy Trevino represented himself to W.B. as a public adjuster. 29. Roy Trevino advertised and/or held himself out to be a public adjuster even though he was not licensed by the Department or appointed by an appropriate appointing entity or person, in violation of Section 626.112(1)(a)}, Florida Statutes. 30, You, EDWARD MICHAEL RUMP, knew, or should have known, that Roy Trevino met with W.B. 31. You, EDWARD MICHAEL RUMP, knew, or should have known, that Roy Trevino advertised and/or held himself out to be insurance adjuster cven though he was not licensed by the Department or appointed by an appropriate appointing entity or person, 32. Roy Trevino solicited public adjusting business from W.B., in violation of Rule 69B-220.051(3)(a), Fla. Admin. Code., and Sections 626.112(1)(a) and (3), Florida Statutes. 33. You, EDWARD MICIIAEL RUMP, knew, or should have known, that Roy Trevino solicited public adjusting business from W.B. 34. Louann Trevino entered into a contract with P.B. and W.B., on behalf of Continental. 35. Roy Trevino inspected W.B.’s home for hurricane damage. 36. Roy Trevino acted as an insurance adjuster when he was not licensed by the Department or appointed by an appropriate appointing entity or person, in violation of Section 626,112(3), Florida Statutes. 6 Mar 19 2008 9:17 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:24AM Pee-se 37, You, EDWARD MICHAEL RUMP, knew, or should have known, that Roy Trevino acted as an insurance adjuster when he was not licensed by the Department or appointed by an appropriate appointing entily or person, IT IS THEREFORE CHARGED that you, LOWANN TREVINO, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department which constitute grounds for the suspension or revocation of your license(s) and eligibility for licensure: (a) Lf the license or appointment is willfully used, or to be used, to circumvent any of (he requirements or prohibitions of this code. [Section 626.61 1(4), Florida Statutes}, (b) Temonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), L'lorida 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]; (d) Violation of any provision of the Florida Insurance Code or any law applicable to the business of insurance in the course of dealing under the licensure or appointment. [Section 626.621(2), llorida Statutes]; (ce) Knowingly aiding, assisting, procuring, advising, or abetting any person in the violation of or to violate a provision of the Florida Insurance Code or any order or rule of the department. [Section 626.621(12), Florida Statutes]. FROM : Mar 19 2008 9:17 DEPT OF FINANCIAL SERWICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:25AM Pel-se COUNT IV 38, The above general allegations arc hereby realleged and fully incorporated herein by reference, 39, On January 2, 2006, Louann Trevino entered into a contract with P.B. and W.B., on behalf of Continental, regarding hurricane damage to P.B.’s and W.B.’s home caused by Hurticane Wilma. 40, You, EDWARD MICHAEL RUMB, knew, or should have known, that, on January 2, 2006, Lonann Trevino entered into a contract with P.B. and W.B., on behalf of Continental. 41. At all times relevant hereto, Louann ‘Trevino was an employee of, or otherwise associated with or employed in some fashion by or with, Continental. 42. At all times relevant hereto, Lovann Trevino was licensed as a public adjuster, but hot appointed with Continental, or any other company, ag required by Sections 626.112(1 )(a) and (3), Florida Statutes. 43. You, EDWARD MICHAEL RUMP, knew, or should have known, that Louarm Trevino was not appointed with Continental, or any other company. 44. Louann Trevino violated Sections 626.112(1)(a) and (3), Florida Statutes. 45, You, EDWARD MICHAEL RUMP, knew, or should have known, that Louann Trevino violated Sections 626.112(1)(a) and (3), Florida Statutes. 46, The contract with W.B. did not contain Louann Trevino’s Florida Department license identification number, Mar 19 2008 9:18 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + 85845749? Mar. 19 2688 @8:25AM P2238 47. You, EDWARD MICHART RUMP, knew, or should have known, that the contract with W.B. did not contain Louarm Trevino’s Florida Department license identification number. IT IS THEREFORE CHARGED that you, LOUANN TREVINO, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department which constitute grounds for the suspension or revocation of your license(s) and cligibility for licensure: (a) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; (b) 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]; (c) Violation of any provision of the Florida Insurance Code or any law applicable to the business of insurance in the course of dealing under the licensure or appointment. [Section 626.621 (2), Florida Statutes]; (d) Violating any provision of this chapler or a rule or order of the department. [Section 626,8698(1), l‘lorida Statutes]; (e) Violating any ethical rule of the Department. [Section 626.8698(6), Florida Statutes); (f) All contracts for public adjuster services must be in writing. The contract must be signed by, the public adjuster who solicited the contract. [Rule 69B-220,051(3)(a), Fla. Admin. Code]; FROM : Mar 19 2008 9:18 DEPT OF FINANCIAL SERWICES FAX NO. + S584o7r4ogr Mar. 129 2668 68:25AM (g) All public adjuster contracts shall show the public adjuster's Florida Department license identification number, [Rule 69B-220.05 1(6)(b)2, Fla. Admin, Code]; (bh) Violation of any lawful order or rule of the department, commission, or office. [Section 626,621(3), Mlorida Statutes). (i) Knowingly aiding, assisting, procuring, advising, or abetting any person in the violation of or to violate a provision ofthe Florida Insurance Code or any order or rule of the department. [Section 626,621(12), Florida Statutes). COUNT V 48. The above general allegations, and paragraph 39, are hereby realleged and fully incorporated herein by reference. 49. P.B.’s and W.B.’s contract states, in pertinent part, “Continental Public Adjusters will not accept or reject any settlement offers on behalf of the Policyholder without the permission and accepiance of the offer by the Policyholder.” 30. On or around July 11, 2006, you, EDWARD MICHAEL RUMP, and Continental accepted a settlement offer from United Property and Casualty Insurance Company (“United”), in the amount of $19,825.99, without W.B.’s permission or acceptance, 31, Although W.B. knew the amount you, EDWARI) MICHAEL RUMP, and Continental accepted was insufficient, W.B. paid you $1,982.59, the agreed upon 10% amount. 52. United, upon reaching this settlement with you, EDWARD MICHAEL RUMP, and Continental, closed W.B.’s claim. 33. W.B., on her own initiative, requested that United reopen the claim, which United did. 54. On or around August 23, 2006, W.B., on her own initiative, requested mediation. 23, On or around October 4, 2006, W.B., with only the help of her general contractor, settled with United prior to the scheduled mediation for an additional $40,203.05. 10 P23-38 Mar 19 2008 9:18 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:25AM Pe4-3a 56. You, EDWARD MICHAEL RUMP, and Continental did not work on W.B.’s claim after you EDWARD MICHAEL RUMP, and Continental accepted the $19,825.99 settlement on or around July 11, 2006. 57, You, EDWARD MICHAEL RUMP, and Continental are not entitled to any portion of the $40,203.05 oblained by W.B. IT IS THEREFORE CHARGED that you, EDWARD MICHAEL RUMP, have violated or afé 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) Demonstrated lack of reasonably adequate knowledge and techical competence to engage in the transactions authorized by the license or appointment, [Section 626.611(8), Florida Statutes]; (c) Violation of any provision of this Code or any law applicable to the business of insurance in the course of dealing under the licensure or appointment. [Section 626.621(2), Florida Statutes |; (d) An adjuster shall subscribe to the code of ethics specified in the rules of the department. The rules shalt implement the provisions of this part and specify the terms and conditions of contracts, including a right to cancel, and require practices necessary lo ensure [air dealing, prohibit conflicts of interest, and ensure preservation of the rights of the claimant to participate in the adjustment of claims [Section 626.878, Florida Statutes]; (c) In the conduct of business under the license or appointment, having otherwise shown himself or herself to be a source of injury or loss to the public. [Section 626.621(6), Florida Statutes]; (Violation of any lawful order or rule of the department, commission, or office. [Section 626,621(3), Florida Statutes}; ll Mar 19 2008 9:18 FROM : DEPT OF FINANCIAL SERVICES FAs NO. : 8564874987 Mar. 19 2688 @8:26AM P25-38 (g) Violating any provision of this chapter or a rule or order of the department. [Section 626,8698(1), Florida Statutes]; (h) Violating any ethical rule of the department. [Section 626.8698(6), Florida Statutes] G) Violating any ethical rule of the Department. [Section 626.8698(6), llorida Statutes]; . (j) An adjuster shall adjust all claims strictly in accordance with the insurance contract, [Rule 69B-220.201(3)(b\(2), Fla. Admin. Code]; (k) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to al) parties without any remuneration to himself except that to which he is legally entitled. [Rule 69B-220.201(3)(c), lla. Admin. Code]; (1) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim. |Rule 69B-220.201(3)(), Fla. Admin. Code]; (m) No public adjuster may settle a claim unless the terms and conditions of settlement are approved by the insured. [Rule 69B-220.051(8), Fla. Admin. Code}. WHERETORE, you, EDWARD MICHAEL RUMP, are hereby notified that the Chief Financial Officer intends to enter an Order suspending or revoking your licenses and appointments as a public adjuster or to immpose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691, and 626.8698, L'lorida Statutes, and under the other referenced Sections of the Florida Statutes as sct 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, llorida Statutes, and Rule 28-106, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be Mar 19 2008 9:19 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + 85845749? Mar. 19 2668 @8:26AM P2638 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 an administrative hearing will suffice as a written request. The request must be filed with the Gencral 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 WATVER OF YOUR RIGHT TO REQUEST A PROCKEDING 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 [lection of Proceeding form conforms to these requirements. Specifically, your response must contain: (a) The name, address, and lelephone 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 slatement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. Mar 19 2008 9:19 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + 85845749? Mar. 19 2688 @8:26AM Perse (d) A statement of when the respondent received notice of the administrative complaint. . (e) A statement including the [ile number to the administrative complaint. Ifa 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-cxamine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. Ifa 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 writlen 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 fecl thal a hearing is necessary, one will be conducted in Tallahassee, Florida, or by telephonic conference call upon your request. However, if you dispule material facts which are the basis for the Department's action, you must request an adversarial procceding 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 arc located elsewhere, the Department will request that the hearing be conducted in Tallahassce, 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 tinely renewed in compliance with the guidelines as set out above. Mediation of this mattcr pursuant to Section 120.573, l‘lorida Statutes, is not available. No Department attorney will discuss this matter with you until the response has been received by 14 Mar 19 2008 9:20 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + 85845749? Mar. 19 2668 @8:27AM Pee-se the Department. DATED and SIGNED this //1 th day of fe bine. , 2008, KAREN CHANDLER Deputy Chief Financial Officer 15 Mar 19 2008 9:20 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:27AM Pease CERTIFICATE. OF SERVICE THEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF PROCEEDING has been furnished to: EDWARD MICHAEL RUMP, 12437 5W 1" Street, Coral Springs, Florida 33071, by Certified Mail this th day of FAG ageiienes , 2008. Robert Alan Fox Senior Attorney Department of Financial Services Division of Legal Services 612 Larson Building 200 East Gaines Street Tallahassee, Florida 32399-0333 e 16 Mar 19 2008 9:20 FROM :DEPT OF FINANCIAL SERVICES FAX NO. + S584o7r4ogr Mar. 19 2668 88:27AM Ps@-s8 STATE OF FLORIDA DEPARTMENT OF FINANCTAL SERVICES DIVISION OF LEGAL SERVICES IN THE MATTER OF: CASE NO.: 89801-07-AG EDWARD MICHAEL RUMP ELECTION OF PROCEEDING Thave received and have read the Administrative Complaint filed by the Florida Department of Financial Services ("Department") against me, including the Notice of Rights contuined therein, and 7 understand try options, Tam requesting disposition of this matter as indicated bclow. (CHOOSE ONE) | 1 do hot dispute any of the Department’s factual allegations and | do not desire a hearing. I understand thal by waiving my Tight (oa heating, the Department may enter a final order that adopts the Administrative Complaint and imposes the sanclions sought, including suspending or revoking my licenses and appointments as may be appropriate. 2, 1 do not dispute any of the Department's factual allegations and I hereby elect a proceeding to be conducted in accordance with Section 120.57(2), Florida Statutes, In this regard, J clesire lo (CHOOSE ONE): I] Submit a written statement and documentary evidence in licu of a hearing; or [] Personally allend a hearing conducted by a department hearing officer in Tallahassee; of {} Attend that same hearing by way of a telephone conference call. 314] 1 dg dispute one of inore of the Department's factual allegations. | hereby request a hearing pursuant to Section 120.57(1), Florida Statutes, to be held before the Division of Administrative Hearings. | have attached to this election form the information required by Rule 28- 106.2015, Tlorida Administrative Code, as specified in subparagraph (c) of the Notice of Rights, Specifivally, | have identified the disputed issues of material fact TO PRESERVE YOUR RIGHT TO A HEARING, YOU MUST FILE YOUR RESPONSE WITH THE DEPARTMENT OF FINANCIAL SERVICES WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THE ADMINISTRATIVE COMPLALN'P. ‘THE RESPONSE MUST BE RIVER HY THE DEPARTMENT NO LATER THAN 5:00 P.M. ON THE TWENTY-FIRST DAY APTER YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT. The address for liling is: Cieneral Counsel acting as Agency Clerk, Florida Department of Financial Services, 612 Larson Building, 200 Hast Gaines Street, Tallahassee, llorida 32399-0333. Si enatu re Print Narne. Date: Address: Date Administrative Complaint Received: If you are represented by an attorney or qualified Phone Na,: —ssnvemunsucurmanuirneerianmnatenerranste=mreaonne _ representative, please attach to this election form his or her name, address, telephone and fax numbers Tax Now 17

Docket for Case No: 08-001390PL