DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Mack, Shelli Joann	DOIID	1210835	NAIC NPN	2525367

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	6/14/2022		9/30/2024
Active	Non Resident	Agent	Property	6/14/2022		9/30/2024
* 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	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	6/17/2022
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	6/17/2022
Active	American Modern Home Insurance Company	300791	Agent - Casualty	7/12/2023
Active	American Modern Home Insurance Company	300791	Agent - Property	7/12/2023
Active	Bristol West Insurance Company	301655	Agent - Casualty	8/14/2023
Active	Bristol West Insurance Company	301655	Agent - Property	8/14/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	8/14/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	8/14/2023
Active	Homesite Insurance Company	301139	Agent - Casualty	10/8/2022
Active	Homesite Insurance Company	301139	Agent - Property	10/8/2022
Active	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/8/2022
Active	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/8/2022
Active	Midvale Indemnity Company	300292	Agent - Casualty	10/8/2022
Active	Midvale Indemnity Company	300292	Agent - Property	10/8/2022

Designated to act on behalf of the following Business Entities

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