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DEPARTMENT OF INSURANCE
Affiliations
Name
Forum Benefits, LLC
DOIID
1115625
NAIC NPN
13721907
License - Line of Authority Information
Status
Residency
Class
Line of Authority
Active Date
Inactive Date
License Expiration Date
Active
Non Resident
Agent
Casualty
1/6/2021
3/31/2025
Active
Non Resident
Agent
Health
1/6/2021
3/31/2025
Active
Non Resident
Agent
Property
1/6/2021
3/31/2025
Active
Non Resident
Agent
Life
1/6/2021
3/31/2025
* If a status Is
Pending, Pending Replacement
,Or the record displays
Affidavit On File
, click On them For more details.
License Renewal Information
Class
Invoice Date
Response Due / Expiration Date
Response Received Date
Payment Received Date
Renewal Complete
Agent
01/15/2025
03/31/2025
Designated Individuals
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Inactive
Berartez, Isabel
1160300
Agent - Health
6/16/2022
4/4/2023
Inactive
Berartez, Isabel
1160300
Agent - Life
6/16/2022
4/4/2023
Active
Falco, Bernard Joseph
705295
Agent - Health
7/7/2021
Active
Falco, Bernard Joseph
705295
Agent - Life
7/7/2021
Inactive
Haskins, Pamela Jean
714491
Agent - Health
6/9/2021
8/5/2021
Inactive
Haskins, Pamela Jean
714491
Agent - Life
6/9/2021
8/5/2021
Active
Levitz, Alan J
312664
Agent - Casualty
1/6/2021
Active
Levitz, Alan J
312664
Agent - Health
1/6/2021
Active
Levitz, Alan J
312664
Agent - Life
1/6/2021
Active
Levitz, Alan J
312664
Agent - Property
1/6/2021
Inactive
Osborn, Diane R
1111351
Agent - Health
12/20/2022
2/15/2023
Inactive
Osborn, Diane R
1111351
Agent - Life
12/20/2022
2/15/2023
Inactive
Post, Julia K
698454
Agent - Health
6/9/2021
6/23/2023
Inactive
Post, Julia K
698454
Agent - Life
6/9/2021
6/23/2023
Denied
Salas, Giovanni Antonio
1125016
Agent - Health
Inactive
Velasquez, Rosa Esmeralda
727792
Agent - Health
7/7/2021
8/5/2021
Inactive
Velasquez, Rosa Esmeralda
727792
Agent - Life
7/7/2021
8/5/2021
Inactive
Whitfield, Cheri
1133878
Agent - Health
10/7/2021
2/24/2022
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