This disclosure was prepared by the California Insurance Commissioner.

Please READ IT CAREFULLY!

I. Do not sign any broker fee agreement unless all of its blank lines and spaces have been filled-in and you have read the entire document and the agreement carefully.

II. Your insurance broker represents you, the consumer, and is entitled to charge a broker fee if he/she chooses. This fee is not set by law, and may be negotiable between you and the broker.

III. It is illegal for an insurance broker to charge you a fee for placing coverage solely with the California Automobile Assigned Risk Plan or the California Fair Plan. Fees may be charged for placement of other coverages.

IV. Broker fees are often non-refundable even if you cancel your coverage. refer to your broker fee agreement to see if your broker fee is non-refundable. However, you may be entitled to a full refund of a broker fee if your broker acted incompetently or dishonestly. Unresolved disputes over nonrefunded broker fees can be forwarded to the Department of Insurance for review.

V. You are entitled to obtain and keep a completed copy of this disclosure and any broker fee agreement you sign.

VI. Your broker may receive a commission from insurance company(ies) for placing your insurance. This commission may be paid to your broker by the insurance company(ies) in addition to any broker fee you pay.

VII. If you will be paying your premium in installments to a finance company, by law you must receive a copy of a premium finance disclosure and agreement. Be sure to obtain and read those documents before signing a premium finance agreement. Also, ask the broker if the insurer offers its own installment payment plan. Insurer installment plans are often cheaper than premium financing through a separate premium finance company.

VIII. If your broker is placing automobile coverage, your broker must provide you with a copy of the current Department of Insurance pamphlet Automobile Insurance. If your broker is placing residential coverage, your broker must provide you with a copy of the current Department of Insurance pamphlet Residential Insurance. By signing this disclosure, you acknowledge receipt of the appropriate pamphlet(s).

Diego Fabian Barco Castillo

License No. 2085754

BROKER’S AGREEMENT

APPOINTMENT OF INSURANCE BROKER AND AGREEMENT TO PAY BROKER FEE

As of this 2023, the undersigned (“Client”) appoints Diego Fabian Barco Castillo. (“Broker”) as his/her insurance broker of record. This Agreement shall continue in full force until terminated by either party. Broker agrees to represent Client honestly and competently in obtaining and servicing the desired insurance coverage, as may be available; and Client agrees to act in good faith with Broker. Client agrees to pay a broker fee for Broker’s services, as specified below. The broker fee is in addition to any commissions which may be paid to Broker by the insurance company. The broker fee is "Per Contract". Client agrees to this fee and understands that the broker fee is/ is not refundable (circle one). Client agrees that in the event the insurance is cancelled or rejected, the broker fee is deemed to be fully earned for services previously rendered by the Broker, and therefore, is not refundable. Broker is authorized to charge $50.00 for each cancellation or reinstatement of the policy(ies) caused by non-payment of premium by the Client and for change (endorsement) of the policy(ies). Client authorizes Broker to maintain premium payments in interest-bearing trust accounts and to receive any interest-income there from until paid to the insurance company.

Other additional applicable fees: Broker may charge a non-refundable processing fee of $ 6.00 for each driver’s motor vehicle record report, and $ 6.00 for each vehicle’s registration obtained by Broker for the submission of Client’s insurance application. Additionally, Broker may charge a non-refundable processing fee of $ 6.00 to split the Client’s down-payment. MVR Fees: $ 5.00 Registration Fees: $ 0.00 Split Down-Payment Fee: $ 10.00

CANCELLATION AND OTHER MISCELLANEOUS PROVISIONS

Broker will only honor cancellation requests made in writing. Broker may provide client with an insurance identification card upon completion of the application process. Client acknowledges and understands that insurance coverage is not provided until the application is underwritten and accepted by the insurance company. Accordingly, the identification cards cannot be used as proof of insurance by the Client until the insurance company has bound and issued coverage as evidenced by a declaration page and/or policy. Broker and Client agree to arbitrate any disputes in which the amount claimed exceeds the Small Claims Court jurisdiction under the rules set up by the American Arbitration Association, ADR, or JAMS, without right of appeal.

SPECIAL POWER OF ATTORNEY

Client hereby appoints Broker, as his/her Attorney-in-Fact, to act in Client’s name and place, and for Client’s use and benefit in connection with obtaining and maintaining insurance for Client. Client hereby grants to said Attorney-in-Fact, full power and authority to perform any act which may be necessary or convenient in connection with any of the foregoing as fully as Client might or could do in person including, but not limited to: Signing and acknowledging insurance applications and papers, including rewrites and renewals, endorsements/change request forms, and endorsing all returned and unearned premiums. Client hereby ratifies and confirms all that said Attorney-in-Fact shall lawfully do or cause to be done by authority hereof. I agree to the conditions set forth above and acknowledge receipt of a copy of this Agreement. I understand this document, the broker fee will be fully earned by Broker and will be non-refundable even if the policy is cancelled.

You have certain rights under state and federal law with respect to the privacy of information we obtain about you when you engage in insurance transactions involving insurance primarily for personal, family, or household use. Because we value our customer relationships, we do not sell customer information. We will only share your information for purposes of placing your insurance and as otherwise permitted by law.

This Privacy Disclosure outlines our information sharing practices to help you understand how we protect your privacy, when we collect and use information about you, and the measures we take to safeguard that information.

COLLECTION OF INFORMATION

We collect nonpublic personal information about you as required to accurately place your insurance with the insurance companies. The categories of nonpublic personal information that we collect about you are from the following sources:

• Information we receive from you on applications or questionnaires, such as your occupation, current employer, address, birth date, marital status, driver’s license number, social security number, and driving record;

• Information about your transactions with us, our affiliates, or previous insurers, such as your policy coverage, claims information, premiums, and payment history; and

• Information we receive from third party reporting agencies, such as motor vehicle reports which disclose driving history and credit reporting agencies.

INFORMATION WE DISCLOSE

We may disclose the following nonpublic personal information about you:

• Information we receive from you on applications or questionnaires, such as your occupation, current employer, address, birth date, marital status, driver’s license number, social security number, and driving record;

• Information about your transactions with us, our affiliates, or previous insurers, such as your policy coverage, claims information, premiums, and payment history; and

• Information we receive from third party reporting agencies, such as motor vehicle reports which disclose driving history and credit reporting agencies.

THIRD PARTIES THAT MAY BE DISCLOSED INFORMATION

We do not disclose any nonpublic personal information about you unless allowed by law. law allows us to share your nonpublic personal information with our affiliates to market products or services to you. You cannot prevent these disclosures.

MEDICAL INFORMATION

We will not disclose medical information about you unless allowed by law or pursuant to your expressed written consent.

CORRECTION OF NONPUBLIC PERSONAL INFORMATION

You have the rights, upon written request to us, to access to and reproduction of nonpublic personal information about you in our possession, and to identification of those persons or entities that we have disclosed nonpublic personal information about you within two years prior to your request. Additionally, you have the right, upon written request, to correction, amendment or deletion of such nonpublic personal information, and, if we disagree with your request, to add your views to our records.

CONFIDENTIALITY AND SECURITY

We protect your nonpublic personal information. The only employees who have access to that information are those who must have it to provide products or services to you. We maintain physical, electronic and procedural safeguard that comply with federal and state regulations to guard your nonpublic personal financial information.