DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ford, Rosetta S	DOIID	982034	NAIC NPN	370477

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Pending Replacement	Non Resident	Agent	Property	1/19/2018		5/31/2025
Pending Replacement	Non Resident	Agent	Health	1/19/2018		5/31/2025
Pending Replacement	Non Resident	Agent	Life	1/19/2018		5/31/2025
Pending Replacement	Non Resident	Agent	Casualty	1/19/2018		5/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Church Mutual Insurance Company, S.I.	301554	Agent - Casualty	2/28/2018	12/5/2023
Pending Replacement	Church Mutual Insurance Company, S.I.	301554	Agent - Health	3/7/2018
Inactive	Church Mutual Insurance Company, S.I.	301554	Agent - Property	2/28/2018	12/5/2023
Inactive	ClearPath Insurance Company	979815	Agent - Casualty	2/28/2024	1/9/2025
Pending Replacement	RLI Insurance Company	301217	Agent - Casualty	8/4/2021
Pending Replacement	RLI Insurance Company	301217	Agent - Property	8/4/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	C M I C Specialty Services Inc	645077	Agent - Casualty	2/28/2018	1/25/2024
Inactive	C M I C Specialty Services Inc	645077	Agent - Property	2/28/2018	1/25/2024
Inactive	C M I C Specialty Services Inc	645077	Agent - Life	11/3/2020	1/25/2024
Inactive	C M I C Specialty Services Inc	645077	Agent - Health	3/7/2018	1/25/2024