DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Worthman, Dustin	DOIID	1044620	NAIC NPN	17202080

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	6/19/2019		8/31/2025
Active	Non Resident	Agent	Property	6/19/2019		8/31/2025
* 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
Active	GuideOne Elite Insurance Company	300490	Agent - Casualty	8/12/2019
Active	GuideOne Elite Insurance Company	300490	Agent - Property	8/12/2019
Active	GuideOne Insurance Company	301794	Agent - Casualty	8/12/2019
Active	GuideOne Insurance Company	301794	Agent - Property	8/12/2019
Active	GuideOne Specialty Insurance Company	300278	Agent - Casualty	8/12/2019
Active	GuideOne Specialty Insurance Company	300278	Agent - Property	8/12/2019
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Casualty	8/30/2022
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Property	8/30/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Cobb B LLC	803227	Agent - Casualty	8/12/2019
Active	Cobb B LLC	803227	Agent - Property	8/12/2019