DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Sullivan, Samuel H	DOIID	1148620	NAIC NPN	20009147

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	4/13/2023	10/31/2023
Inactive	Resident	Agent	Property	8/16/2021	10/31/2023
Inactive	Resident	Agent	Health	4/13/2023	10/31/2023
Inactive	Resident	Agent	Casualty	8/19/2021	10/31/2023
* 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	Bankers Life and Casualty Company	300701	Agent - Health	4/13/2023	10/31/2023
Inactive	Bankers Life and Casualty Company	300701	Agent - Life	4/13/2023	10/31/2023
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Health	4/13/2023	10/31/2023
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Life	4/13/2023	10/31/2023
Inactive	Erie Insurance Company	300230	Agent - Casualty	8/26/2021	3/15/2023
Inactive	Erie Insurance Company	300230	Agent - Property	8/26/2021	3/15/2023
Inactive	Erie Insurance Company of New York	789916	Agent - Casualty	8/26/2021	3/15/2023
Inactive	Erie Insurance Company of New York	789916	Agent - Property	8/26/2021	3/15/2023
Inactive	Erie Insurance Exchange	300789	Agent - Casualty	8/26/2021	3/15/2023
Inactive	Erie Insurance Exchange	300789	Agent - Property	8/26/2021	3/15/2023
Inactive	Erie Insurance Property & Casualty Company	789942	Agent - Casualty	8/26/2021	3/15/2023
Inactive	Erie Insurance Property & Casualty Company	789942	Agent - Property	8/26/2021	3/15/2023
Inactive	Flagship City Insurance Company	789965	Agent - Casualty	8/26/2021	3/15/2023
Inactive	Flagship City Insurance Company	789965	Agent - Property	8/26/2021	3/15/2023
Inactive	Humana Insurance Company	301104	Agent - Health	5/31/2023	7/6/2023
Inactive	Washington National Insurance Company	300587	Agent - Health	4/13/2023	10/31/2023
Inactive	Washington National Insurance Company	300587	Agent - Life	4/13/2023	10/31/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bluegrass Insurance Services LLC	687604	Agent - Casualty	8/31/2021	3/15/2023
Inactive	Bluegrass Insurance Services LLC	687604	Agent - Property	8/31/2021	3/15/2023