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Privacy
Derian Insurance Agency, Inc
Privacy Policy Notice
as of { July 1, 2001}
PURPOSE OF THIS NOTICE
Title V of the Gramm-Leach-Bliley Act (GLBA) and the laws of
the State of California generally prohibit us from sharing
nonpublic personal information about you with a third party
unless we provide you with this notice of our privacy
policies and practices describing the type of information
that we collect about you and the categories of persons or
entities to whom that information may be disclosed. In
compliance with the GLBA and California law, we are
providing you with this document, which notifies you of the
privacy policies and practices of { Derian Insurance Agency
}
OUR PRIVACY POLICIES AND PRACTICES
1. Information we collect:
A. Categories of Information Collected and Sources From
Which We Collect It.
We collect nonpublic personal information about you from the
following sources:
1) Information that you provide us on applications and other
forms.
2) Information about your transactions with us from the
insurance companies we contact
to underwrite your insurance.
3) Information we receive from the Department of Motor
Vehicles or other consumer
reporting agencies.
4) Information contained in medical records or from medical
professionals that is related
to insurance claims.
Unless it is specifically stated otherwise in an amended
Privacy Policy Notice, no additional information will be
collected about you.
B. Persons From Whom Information is Collected.
We may collect nonpublic personal information from
individuals other than those proposed
for coverage.
2. Information we may disclose to third parties:
We do not disclose information about you to third parties
whose only use of the information is to market a product or
service. However, in the course of our general business
practices, we may disclose the information that we collect
(as described above) about you or others without your
permission to the following types of institutions for the
reasons described below:
A. To a third party if the disclosure will enable that party
to perform a business, professional
or insurance function for us.
B. To an insurance institution, agent, or credit reporting
agency in order to detect or prevent
criminal activity, fraud or misrepresentation in connection
with an insurance transaction.
C. To an insurance institution, agent, or credit reporting
agency for either this agency or the
entity to whom we disclose the information to perform a
function in connection with an
insurance transaction involving you.
D. To a medical care institution or medical professional in
order to verify coverage or benefits,
inform you of a medical problem of which you may not be
aware, or conduct an audit that
would enable us to verify treatment.
E. To the California Department of Insurance or other
insurance regulatory authority, law
enforcement, or other governmental authority in order to
protect our interests in preventing
or prosecuting fraud, or if we believe that you have
conducted illegal activities.
F. To a group policyholder for the purpose of reporting
claims experience or conducting an audit
of our operations or services.
3. Your right to access and amend your personal information:
You have the right to request access to the personal
information that we record about you. Your right includes
the right to know the source of the information and the
identity o the persons, institutions or types of
institutions to whom we have disclosed such information
within 2 years prior to your request. Your right includes
the right to view such information and copy it in person, or
request that a copy of it be sent to you by mail (for which
we may charge you a reasonable fee to cover our costs). Your
right also includes the right to request corrections,
amendments or deletions of any information that is in our
possession. The procedures that you must follow to request
access to or an amendment of your information are as
follows:
To obtain access to your information: You should submit a
request in writing to { Larklo Der Sarkisian, president /
Derian Insurance Agency / PO Box 49518 / Los Angeles CA
90049 }. The request should include your name, address,
social security number, telephone number, and the recorded
information to which you would like access. The request
should state whether you would like access in person or a
copy of the information sent to you by mail. Upon receipt of
your request, we will contact you within 30 business days to
arrange providing you with access in person or the copies
that you have requested.
To correct, amend, or delete any of your information: You
should submit a request in writing to { Larklo Der Sarkisian,
president / Derian Insurance Agency / PO Box 49518 / Los
Angeles CA 90049 }. The request should include your name,
address, social security number, telephone number, the
specific information in dispute, and the identity of the
document or record that contains the disputed information.
Upon receipt of your request, we will contact you within 30
business days to notify you either that we have made the
correction, amendment or deletion, or that we refuse to do
so and the reasons for the refusal, which you will have the
opportunity to challenge.
4. Our practices regarding information confidentiality and
security:
We restrict access to nonpublic personal information about
you to those employees who need to know that information in
order to provide products or services to you. We maintain
physical, electronic, and procedural safeguards that comply
with federal regulations to guard your nonpublic personal
information.
5. Our policy regarding dispute resolution:
Any controversy or claim arising out of or relating to our
privacy policy, or the breach thereof, shall be settled by
arbitration in accordance with the rules of the American
Arbitration Association, and judgment upon the award
rendered by the arbitrator(s) may be entered in any court
having jurisdiction thereof.
6. Reservation of the right to disclose information in
unforeseen circumstances:
In connection with the potential sale or transfer of its
interests, { Derian Insurance Agency }, and its affiliates
(if any), reserve the right to sell or transfer your
information (including but not limited to your name,
address, age, sex, zip code, state and country of residency,
and other information that you provide through other
communications) to a third party entity that (1)
concentrates its business in a similar practice, product or
service; (2) agrees to be Derian Insurance Agency’s
successor in interest with regard to the maintenance and
protection of the information collected; and (3) agrees to
the obligations of this privacy statement.
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