DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fulgham, Dallas L	DOIID	1187510	NAIC NPN	20215952

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	2/10/2022	8/10/2023
Inactive	Non Resident	Agent	Casualty	2/10/2022	8/10/2023
* 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	2/14/2022	7/27/2023
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	2/14/2022	7/27/2023
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	6/5/2023	8/3/2023
Inactive	Bristol West Insurance Company	301655	Agent - Property	6/5/2023	8/3/2023
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/5/2023	8/3/2023
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/5/2023	8/3/2023
Inactive	Homesite Insurance Company	301139	Agent - Casualty	10/8/2022	8/10/2023
Inactive	Homesite Insurance Company	301139	Agent - Property	10/8/2022	8/10/2023
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/8/2022	8/10/2023
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/8/2022	8/10/2023
Inactive	Midvale Indemnity Company	300292	Agent - Casualty	10/8/2022	8/10/2023
Inactive	Midvale Indemnity Company	300292	Agent - Property	10/8/2022	8/10/2023
Inactive	RLI Insurance Company	301217	Agent - Casualty	5/31/2023	7/27/2023
Inactive	RLI Insurance Company	301217	Agent - Property	5/31/2023	7/27/2023

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	5/24/2023	8/10/2023
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	5/24/2023	8/10/2023