Hurst-Weiss Insurance Agency, Inc.  Privacy Statement

 Title V of the Gramm-Leach-Bliley Act (GLBA) generally prohibits any financial institution, directly or through affiliates, from sharing nonpublic personal information about you with a nonaffiliated third party unless the institution provides you with a notice of its privacy policies and practices, such as the type of information that it collects about you and the categories of persons or entities to whom it may be disclosed.  In compliance with the GLBA, we are providing you with this document, which notifies you of the privacy policies and practices of Hurst-Weiss Insurance Agency, Inc. 

The GLBA further requires that we inform you that you have a right to prevent us from sharing nonpublic personal information about you with a nonaffiliated third party for any purpose that is not specifically authorized by law.  Your right to prevent us from sharing nonpublic personal information about you with nonaffiliated third party for a purpose that is not specifically authorized by law is called your right to “opt out” of such information sharing. 

At Hurst-Weiss Insurance Agency, Inc. we are committed to providing you the best service while earning your trust and protecting the privacy of your information.  We understand and respect the fact that you may wish to keep your personal information confidential. 

The following is our policy on how we handle your information:

1.  Collection of your information 

We collect nonpublic personal financial information about you from the following sources:

 ·          Information from applications.  This is information you give us on applications and other forms, by phone or on line.  This information includes your name, address, telephone number, drivers license number, Social Security number, date of birth, length of employment, gender, marital status, prior insurance information, status of home ownership, length of residency, vehicle description, miles driven, and vehicle use/driving history that we receive from you on applications or other forms.

·          Information about transactions.  This is information about your trusted transactions with us and our affiliates.  It includes your insurance coverage premiums and selection, your payment and claims history and information necessary for billing and payment.  Other information used to investigate and settle claims, such as witness statements and policy reports, may be included as well.

·          Information we receive from a consumer reporting agency.  This information is generally used to confirm or supplement application information.  We disclose consumer report information only as necessary to quote or service your insurance policy and as permitted by law.  By obtaining a quote, you consent to our sharing this information with companies and their affiliates for underwriting purposes. 

2.  Disclosure Policy

 We may disclose all of the information that we collect as described above.

 3.  Nonaffiliated third parties to whom disclosure may be made

 a) Disclosure to nonaffiliated third parties

 We may disclose nonpublic personal financial information about you to the following types of third parties:

·          financial services providers, such as mortgage bankers and lenders, securities broker-dealers,

·          nonfinancial companies, such as automobile, boat and RV  dealerships,

·          we may also disclose nonpublic personal information about you to nonaffiliated third parties as permitted by law.

 b)  Notification of your rights to “opt out” of certain disclosures

 As we have indicated in this Privacy Policy Notice, we collect certain nonpublic personal information about you, and we disclose that information to certain nonaffiliated third parties for the purposes other than those expressly permitted by the Gramm-Leach-Bliley Act and the federal and state regulations implementing that act.  If you prefer that we not disclose nonpublic personal information about you to nonaffiliated third parties, you may “opt out” of those disclosures, that is, you may direct us not to make those disclosures, (other than those disclosures that are expressly permitted by the Gramm-Leach-Bliley Act and its implementing regulations).

If you wish to “opt out” of such disclosures to nonaffiliated third parties, you may:

·          e-mail us at info@Hurstweiss.com

·          check the appropriate box on reverse side of this form and mail to the address on this form

4.  Affiliates with whom we share certain information protected by the Fair Credit Reporting Act, unless you tell us not to:

a.  Information we can share with our affiliates, unless you tell us not to:

Unless you tell us not to, we may share with our affiliated companies information about you including:

·          information we obtain from your insurance application, such as your income or your marital status;

·          information we obtain from a consumer report, such as your credit score or credit history;

·          information we obtain to verify representations made by you, such as your open lines of credit; and

·          information we obtain from a person regarding its employment, credit, or other relationship with you, such as employment history.

b. Our affiliated companies who may receive this information are:

 ·          financial services providers, such as mortgage bankers and lenders, securities broker dealers,

·          nonfinancial companies, such as automobile, boat and RV dealerships.

 c. How to tell us not to share this information with our affiliated companies:

If you prefer that we not share this information with our affiliated companies, you may direct us not to share this information by doing the following:

·          call us toll free at 800-511-7965

·          e-mail us at info@Hurstweiss.com

·          check the appropriate box below and mail to the address on this form indicated below

5. Confidentiality and security

 We restrict access to nonpublic personal financial information about you to those employees who need to know that information to provide products and services to you.  We maintain physical, electronic and procedural safeguards that comply with federal and state regulations to guard your nonpublic personal financial information. 

6.  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.

7.  Reservation of the right to disclose information in unforeseen circumstances

 In connection with the potential sale or transfer of its interests, Hurst-Weiss Insurance Agency, Inc. reserves the right to sell or transfer information (including, but not limited to, your address, name, 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 it business in a similar practice or service; 2) agrees to be Hurst-Weiss Insurance Agency, Inc.’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.

8.  Customer acknowledgment and signature

 By signing my name below, I am indicating that I have read the privacy policy of Hurst-Weiss Insurance Agency, Inc. and understand the terms.  No promises or representations have been made to induce me to sign this form.

____________________                                                                        _______________________________________

Date                                                                                                        Customer Signature

____________________________________

Customer Name Printed

“Opt out” Form

 Please read the text below and decide whether you wish to exercise your right to “opt out” of the information sharing described.  If you choose to exercise your right to “opt out”, you must mail this form back to us at  Hurst-Weiss Insurance Agency, Inc.  485 Mansfield Avenue,  Pittsburgh, PA  15205.  Your response must be postmarked no later than 30 days from the date you receive this notice from us in person in order for it to be valid.  If you do not mail this form back in 30 days, you have not exercised your “opt out” right and we can share the information described. 

________ I wish to exercise my right under the Gramm-Leach-Bliley Act to “opt out” of Hurst-Weiss Insurance Agency, Inc.’s sharing of nonpublic personal information about me to nonaffiliated third parties other than those permitted by law. 

________ I wish to exercise my right under the Fair Credit Reporting Act to “opt out” of Hurst-Weiss Insurance Agency, Inc.’s sharing nontransactional information about me to affiliates.