OCI Administrative Action

MARK V. AFABLE Commissioner of the Office of Insurance

OCI ADMINISTRATIVE ACTIONS

Madison, WI—OCI has taken the following administrative actions. In many of these cases the respondent denied the allegations but consented to the action taken. Any forfeitures paid in these administrative actions are deposited in the Common School Fund which is administered by the Board of Commissioners of Public Lands. The earnings from this fund are distributed to all public K-12 schools in Wisconsin and are used by school libraries to purchase books. Copies of the administrative action orders may be viewed online at https://ociaccess. oci.wi.gov/OrderInfo/OrdInfo.oci.

JUNE, 2021

Allegations & Actions Against Agents Michele Lee Diamond, 8275 E Wood Dr., Scottsdale, AZ 85260, agreed to permanently surrender her Wisconsin insurance license and agreed to pay a forfeiture of $2,000.00 upon the submission of any future licensing application. These actions were taken based on allegations of allowing a revoked insurance agent to use her license to engage in the business of insurance. Thomas A. Griesman, 416 E Washington St, Burlington, WI 53105, agreed to pay a forfeiture of $2,000.00 and agreed to the issuance of a two-year conditional insurance license having certain employment, supervision, and reporting requirements. These actions were taken based on failing to timely disclose criminal charges to OCI and having a criminal conviction that may be substantially related to insurance marketing type conduct. Gerald B. Lynch, 1917 Belgium Dr., Plano, TX 75025, had his application for an insurance license denied. This action was taken based on allegations of failing to disclose administrative actions taken by the states of Wisconsin, South Dakota, Louisiana, and California on a licensing application; failing to timely report to OCI administrative actions taken by other states while licensed in Wisconsin; failing to comply with a forfeiture order; failing to respond to inquiries from OCI; and failing to provide information required to complete a licensing application. Nathan R. Miller, 101 Seabreeze Blvd., Apt. 507, Daytona Beach, FL 32118, was ordered to pay a forfeiture of $500.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of Virginia, California, and NC. Daniel W. Raymaker, 701 Alpine Rd., Algoma, WI 54201, had his application for an insurance license denied for 60 days. This action was taken based on allegations of failing to disclose an administrative action taken by the State of Wisconsin on a licensing application and failing to provide documentation required to complete the application.

JULY, 2021

Allegations & Actions Against Agents Jumuel A. Cannon, 4626 W. Deer Run Dr., Apt. 204, Brown Deer, WI 53223, had her insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes.

Stanford L. Clacks, Jr., 5132 Brandenburg Way, Madison, WI 53718, had his application for an insurance license denied for 90 days. This action was taken based on allegations of failing to disclose administrative actions taken by the states of Indiana and Wisconsin on a licensing application and failing to timely disclose an administrative action taken by the State of Indiana while actively licensed in Wisconsin. Heather L. Cruver, 1523 Lincoln Ave., Plattsmouth, NE 68048, had her insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Dynah R. Edang, 3772 E Pulaski Ave., Cudahy, WI 53110, had her application for an insurance license denied for 60 days. This action was taken based on allegations of failing to disclose an administrative action taken by the State of Wisconsin on a licensing application. Nicole R. Etter, 4119 N Woodburn St., Shorewood, WI 53211, had her application for an insurance license denied for 31 days. This action was taken based on allegations of failing to disclose administrative actions taken by the states of Washington and Wisconsin on a licensing application, and failing to fully complete an application form. Thomas Giebel, 3678A E Birchwood Ave., Cudahy, WI 53110, had his insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Beth Gifford, 3171 Dayton St., Magna, UT 84044, was ordered to pay a forfeiture of $500.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of South Dakota, Louisiana, and California.

Beth Gifford, 3171 Dayton St., Magna, UT 84044, had her insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Piroshka Gowdy, 1342 S Glen Cir., Apt. C, Aurora, IL 60506, had her insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Paul Haan, 3969 Bayshore Dr., Sturgeon Bay, WI 54235, was ordered to pay a forfeiture of $500.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of South Dakota, Kansas, and Indiana. Paul Haan, 3969 Bayshore Dr., Sturgeon Bay, WI 54235, had his insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Phillip E. Ipsan, 1040 Bayview Dr., Ste. 610, Fort Lauderdale, FL 33304, had his insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture.

Francis Jablonski, 115 Washington St., Fountain City, WI 54629, had his application for an insurance license denied for 31 days. This action was taken based on allegations of having a criminal conviction that may be substantially related to insurance marketing type conduct. Jaimie A. Jackson, 13601 S 44th St., Apt. 3035, Phoenix, AZ 85044, had her insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Jose D. Jaramillo Arvizu, 2101 N Evergreen St., Apt. 10445, Chandler, AZ 85225, had his insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Jose D. Jaramillo Arvizu, 2290 E Yeager Dr., Chandler, AZ 85286, was ordered to pay a forfeiture of $500.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of Louisiana, Indiana, North Carolina, and California. Jeremiah R. Johnson, 3019 N 47th St., Milwaukee, WI 53210, had his insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Cokilya Keith, 420 Pilot Rd., Las Vegas, NV 89119, was ordered to pay a forfeiture of $500.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of Virginia, Washington, and Louisiana. Cokilya Keith, 807 1/2 S 3rd St., Las Vegas, NV 89101, had his insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Taimur Khan, 102 N Water St., Unit 401, Milwaukee, WI 53202, agreed to the issuance of a conditional license having a 30-day denial period and certain disclosure requirements. This action was taken based on allegations of having criminal convictions that may be substantially related to insurance marketing type conduct, failing to fully disclose the convictions on a licensing application, and failing to provide information requested by OCI. Kristine L. Larson, 319 N Madison St., Waupun, WI 53963, had her insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Theresa M. Lasee, 2757 Moose Creek Trl., Green Bay, WI 54313, had her insurance license summarily suspended. This action was taken based on allegations of committing financial fraud. CONTINUED ON PAGE 16

Kabir Leon, 300 Forest Center Dr., Apt. 31102, Kingwood, TX 77339, had his insurance license revoked. This action was taken based on allegations of failing to pay a non-resident licensing fee. Darlene M. Mosbaugh, 75443 Schmenski Rd., Glidden, WI 54527, had her insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Sean P. O’Connor, 519 N 93rd St., Milwaukee, WI 53226, had his insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Jonathan I. Oner, 817 15th Ave., Unit 210, Monroe, WI 53566, had his application for an insurance license denied. This action was taken based on allegations of having criminal convictions that may be substantially related to insurance marketing type conduct and failing to provide documentation required to complete a licensing application. Eric Oster, Jr., 1946 Fittin Ct., Lantana, FL 33461, had his insurance license revoked. This action was taken based on allegations of failing to pay a non-resident licensing fee. Jason W. Perez, 13328 W Stella Ln., Litchfield Park, AZ 85340, was ordered to pay a forfeiture of $500.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of Florida, Indiana, and California.

Jason W. Perez, 13328 W Stella Ln., Litchfield Park, AZ 85340, had his insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Jose I. Perez-Hernandez, 2615 N. Cramer St., Apt. 36, Milwaukee, WI 53211, had his insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Carla J. Petersen, 615 Stow St., Fond du Lac, WI 54935, had her insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Rolando A. Rodriguez, 5255 S 22nd St., Milwaukee, WI 53221, had his application for an insurance license denied for 60 days. This action was taken based on allegations of failing to disclose administrative actions taken by the states of California and Wisconsin on a licensing application and failing to timely provide documentation required to complete a licensing application. Chad M. Schampers, 2004 Ledgeview Rd., De Pere, WI 54115, had his application for an insurance license denied. This action was taken based on allegations of having criminal convictions that may be substantially related to insurance marketing type conduct; being named in lawsuits containing allegations of fraud, misrepresentation, misappropriation, or breach of fiduciary duty; demonstrating financial irresponsibility in the conduct of business; providing false and incomplete information on a licensing application; and failing to apply for and obtain a federal crime waiver.

Theron “Terry” G. Seitz, 1865 Arrowhead Dr., Beloit, WI 53511, had his insurance license revoked. This action was taken based on allegations of owing delinquent Wisconsin taxes. Lewis Shaver, 6663 Seaway Dr., Brooksville, FL 34604, was ordered to pay a forfeiture of $4,000.00. This action was taken based on allegations of failing to timely disclose to OCI administrative actions taken by the states of Kentucky, Utah, Indiana, Nebraska, Illinois, Louisiana, Virginia, and Maryland. Lewis Shaver, 6663 Seaway Dr., Brooksville, FL 34604, had his insurance license revoked. This action was taken based on allegations of failing to timely pay an ordered forfeiture. Adam Sokeland, 2888 Joellen Ln., Apt. 2C, Newburgh, IN 47630, had his application for an insurance license denied. This action was taken based on allegations of owing delinquent child support. Richard J. Wilkinson, 5215 W Wiley Post Way, Ste. 200, Salt Lake City, UT 84116, was ordered to pay a forfeiture of $500.00 and was ordered to provide all information requested by OCI regarding a consumer complaint, and to timely and fully respond to all inquiries from OCI. These actions were taken based on allegations of failing to timely respond to inquiries from OCI. Andrew Williams, 4509 N 108th St., Wauwatosa, WI 53225, had his application for additional insurance authority denied. This action was taken based on allegations of failing to timely respond to inquiries from OCI, failing to disclose an employment termination for cause on a licensing application, and falsifying information on insurance applications. Andrew Williams, 4509 N 108th St., Wauwatosa, WI 53225, had his application for additional insurance authority denied. This action was taken based on allegations of failing to disclose an administrative action taken by the State of Wisconsin on a licensing application; having an insurance company appointment termination for cause; failing to respond promptly to OCI requests for information; and providing false information on a previous licensing application. H

OCI is responsible for overseeing the operations and marketing of insurance companies and agents in Wisconsin. OCI encourages anyone with a question or a complaint regarding an insurance company or agent to contact the office at this toll-free telephone number: 1-800-236-8517.

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