LEUSCH Insurance Services Agency, Inc.

Privacy Policy Notice

(As of June 30, 2001)

PURPOSE OF THIS NOTICE

Title V of the Gramm-Leach-Bliley Act (GLBA) generally prohibits any financial institution, directly or through its 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 this agency.

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 a nonaffiliated third party for a purpose that is not specifically authorized by law is called your right to “opt-out” of such information sharing.

OUR PRIVACY POLICIES AND PRACTICES

1. Information we collect:

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

                                · Information we receive from you on applications or other forms.

· Information about your transactions with us, our affiliates or others.

· Information we receive from a consumer reporting agency.

Unless it is specifically stated otherwise in an amended Privacy Policy Notice, no additional information will be collected about you.

2. Information we may disclose to third parties:

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

3. Disclosures to nonaffiliated third parties:

                A.                Nonaffiliated Third Parties to Whom Disclosures May Be Made

We may disclose nonpublic personal information about you to the following types of third parties, unless you tell us not to: 

·          Financial service providers, such as life insurers, automobile insurers, mortgage bankers, securities broker-dealers, and insurance agents;

· Non-financial companies, such as retailers, direct marketers, and publishers, and

· Others, such as nonprofit organizations.

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

B.                Notification of Your Right 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 may disclose that information to certain nonaffiliated third parties for 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 check the appropriate box on the attached form and return as indicated.

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 opt-out:

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 source regarding its employment, credit, or other relationship with you, such as your employment history.

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

                                · Financial service providers, such as mortgage lenders and brokers;

· Non-financial companies, such as retailers, direct marketers, and publishers;

· Our other affiliates, such as nonprofit organizations

C.                How to tell us not to share your information:

If you prefer that we not share this information with our affiliated companies, you may direct us not to share this information by checking the appropriate box on the attached form and return as indicated.

5. 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.

6. 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.

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

In connection with the potential sale or transfer of its interests, this agency and its affiliates reserve the right to sell or transfer your 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 its business in a similar practice or service; (2) agrees to be this 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.

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 this address:

LEUSCH Insurance Services Agency, Inc.

16903 Fischer Road

Cleveland, Ohio  44107-5539

Your response must be postmarked no later than 30 days from the date you received this notice from us in person in order for it to be valid. If you do not mail this form back or do not mail it back within 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 this agency's sharing nonpublic personal information about me to nonaffiliated third parties for purposes other than those that are permitted by law.

______ I wish to exercise my right under the Fair Credit Reporting Act to opt-out of this agency's sharing non-transactional information about me to affiliates.

___________________________________

Customer Name

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Customer Signature                                                Date