DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Mary Jo	DOIID	1119753	NAIC NPN	6824538

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	2/8/2021	10/2/2023
Inactive	Non Resident	Agent	Property	2/8/2021	10/2/2023
* 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	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	2/11/2021	10/2/2023
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	2/11/2021	10/2/2023
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	8/1/2023	10/2/2023
Inactive	American Modern Home Insurance Company	300791	Agent - Property	8/1/2023	10/2/2023
Denied	Bristol West Insurance Company	301655	Agent - Casualty
Denied	Bristol West Insurance Company	301655	Agent - Property
Denied	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty
Denied	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property
Inactive	Homesite Insurance Company	301139	Agent - Casualty	11/14/2022	10/2/2023
Inactive	Homesite Insurance Company	301139	Agent - Property	11/14/2022	10/2/2023
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	11/14/2022	10/2/2023
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Property	11/14/2022	10/2/2023
Inactive	Midvale Indemnity Company	300292	Agent - Casualty	11/14/2022	10/2/2023
Inactive	Midvale Indemnity Company	300292	Agent - Property	11/14/2022	10/2/2023
Denied	Progressive Casualty Insurance Company	300696	Agent - Casualty
Denied	Progressive Casualty Insurance Company	300696	Agent - Property
Denied	United Financial Casualty Company	301886	Agent - Casualty
Denied	United Financial Casualty Company	301886	Agent - Property

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	8/15/2023	10/2/2023
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	8/15/2023	10/2/2023