Conservation and Liquidation Office

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CONSERVATION &
LIQUIDATION OFFICE

Conflict of Interest Statement
Year 2009 - 2010

This document establishes policy guidelines and procedures for conflict of interest issues pertaining to employees of the CLO.

In general, conflicts of interest relate to the potential for self-gain usually, but not always, of a fiscal nature. Potential for self-gain can serve to undermine the judgment or objectivity of CLO employees such that their mission and dedication to the CLO are compromised. Furthermore, not only bias, but the appearance of bias, may undermine public trust in the CLO.

A potential or actual conflict of interest exists when commitments and obligations to the CLO, or to widely recognized professional norms, are likely to be compromised by a person’s other interests or commitments, especially economic, particularly if those interests or commitments are not disclosed.

The activities stated below do not attempt to specify every possible limitation on officers’ and employees’ activities that might be determined to fall within the scope and proscriptions of an incompatible activity.

It is not the intent of the CLO to inquire into the private affairs of its officers or employees, or to limit the rights granted by the laws of the United States and the State of California.

Activities and/or enterprises deemed to fall in these categories shall include, but not be limited to, all of the following:

Check One

Have you held beyond ten (10) days after the start of employment with the CLO any license or permit issued under the Insurance Code?

If yes, please explain:

Yes
No

Are you a Board member, officer, agent or employee of an insurer or directly or indirectly interested in any insurer or licensee under the Insurance Code, except (a) as a policyholder, or, (b) by virtue of relationship by blood or marriage to any person interested in an insurer or licensee?

If yes, please explain:

Yes
No

Have you solicited business from any licensee, permitee, certificate holder, or registrant under the Insurance Code or any applicant for such license, permit, certificate or registration?

If yes, please explain:

Yes
No

Are you, in a representative or official capacity, negotiating with any licensee, permitee, certificate holder or registrant under the Insurance Code when such negotiating is outside the scope of the employee’s CLO responsibilities?

If yes, please explain:

Yes
No

Have you used CLO time, facilities, equipment, or supplies for private gain or advantage?

If yes, please explain:

Yes
No

Are you engaged in any outside employment, activity, or enterprise which involves the use of CLO time, records, equipment, facilities, or personnel?

If yes, please explain:

Yes
No

Have you engaged in any outside auditing, accounting, practice of of law, or other outside activity or employment in which it is reasonably foreseeable that such activities may later be subject to the direct or indirect control, inspection, review, audit, or regulation by the Department of Insurance?

If yes, please explain:

Yes
No

Have you used or gained access to, confidential information available by virtue of CLO employment for private gain or advantage or providing confidential information to persons to whom issuance of this information has not been authorized?

If yes, please explain:

Yes
No

In a representative or official capacity, have you suggested or referred a person to any specific attorneys-at-law or law firms on any insurance matter whatsoever?

If yes, please explain:

Yes
No

10.

Have you received or accepted money or any other consideration from anyone other than the CLO for the performance of your duties as a CLO officer or employee?

If yes, please explain:

Yes
No

11.

Have you performed an act in other than your capacity as a CLO officer or employee knowing that the act may later be subject, directly or indirectly, to the control, inspection, review, audit, or enforcement by the officer or employee?

If yes, please explain:

Yes
No

12.

Have you received or accepted, directly or indirectly; by family or friends, any gifts, including money, or any service, gratuity, favor, entertainment, hospitality, loan, or any other item of value from anyone (or those acting on their behalf) who is doing or is seeking to do business of any kind with the Department of Insurance or CLO, or whose activities are regulated or controlled by the CLO, under circumstances from which it reasonably could be substantiated or reasonably inferred that the gift was intended to influence the officer or employee in his or her official duties, or was intended as a reward for any official actions performed by the officer or employee?

If yes, please explain:

Yes
No

13.

Subject to any other laws, rules, or regulations as pertain thereto, have you ever not devoted your full-time attention and efforts to your office or employment during your hours of duty as a CLO officer or employee?

If yes, please explain:

Yes
No

14.

Are you representing and/or selling, directly or indirectly, insurance instruments; e.g., insurance policies, surety bonds, etc.?

If yes, please explain:

Yes
No

15.

In a representative or official capacity, have you endorsed, promoted or contributed to political campaigns or candidates?

If yes, please explain:

Yes
No

16.

I have read the Incompatibility Activities Statement included in the CLO Employee Handbook and am not aware of any incompatible activities.

If no, please explain:

Yes
No

17.

I have received a copy of the CLO’s Code of Business Conduct and Ethics and understand that I am responsible for reading and understanding the policy. If I have questions regarding the content or interpretation of this policy, I will bring them to the attention of the CLO’s Chief Executive Officer.

Yes
No

NAME:		DATE:
SIGNATURE:

July 2009