Costello Insurance
Associates, Inc.
Tel: 800.528.6483
Tel: 480.968.7746
Fax: 480.967.3828
insure@aviationi.com
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Pat Costello,
President |
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PURPOSE OF
THIS NOTICE
Title
V of the Gramm-Leach-Bliley Act (GLBA) and the
laws of the State of Arizona 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 Arizona
law, we are providing you with this document,
which notifies you of the privacy policies and
practices of Costello Insurance Associates,
Inc.
OUR PRIVACY POLICIES
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.
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 Arizona 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 of 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 Pat Costello, President, Costello
Insurance Assoc. Inc. / P O Box 28280 Tempe, AZ
85285-8280. 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
the 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 Pat Costello, President,
Costello Insurance Assoc. Inc. / P O Box 28280
Tempe, AZ 85285-8280. 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 resolutions:
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 interest,
Costello Insurance Assoc. Inc., 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 Costello Insurance
Assoc. 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.
7. Customer
acknowledgement and signature:
By
signing my name below, I am indicating that I have
read the privacy policy of Costello Insurance
Assoc. Inc. and that I understand its terms. No
promises or representations have been made to me
to induce me to sign this
form.
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