DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Pack, Lori Ellyn	DOIID	1065216	NAIC NPN	18012361

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	11/14/2019		9/30/2025
Active	Non Resident	Agent	Life	11/14/2019		9/30/2025
Active	Non Resident	Agent	Health	11/14/2019		9/30/2025
Active	Non Resident	Agent	Property	11/14/2019		9/30/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	1/5/2022		9/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	RSG Specialty, LLC	726176	Agent - Casualty
Denied	RSG Specialty, LLC	726176	Agent - Life
Denied	RSG Specialty, LLC	726176	Agent - Health
Denied	RSG Specialty, LLC	726176	Agent - Property