DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Tori Ann	DOIID	1033751	NAIC NPN	17413735

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	4/3/2019	6/23/2020
Inactive	Non Resident	Agent	Property	4/3/2019	6/23/2020
Inactive	Non Resident	Agent	Health	4/3/2019	6/23/2020
Inactive	Non Resident	Agent	Life	4/3/2019	6/23/2020
* 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	Guardian Life Insurance Company of America	301316	Agent - Health	4/1/2020	6/23/2020
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	4/1/2020	6/23/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Paychex Insurance Agency Inc	509469	Agent - Casualty
Denied	Paychex Insurance Agency Inc	509469	Agent - Health
Denied	Paychex Insurance Agency Inc	509469	Agent - Life
Denied	Paychex Insurance Agency Inc	509469	Agent - Property