DEPARTMENT OF INSURANCE

Affiliations

Name	Sam'S Club Insurance Services, LLC	DOIID	1242448	NAIC NPN	20527013

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	11/15/2022	3/31/2028
Active	Non Resident	Agent	Property	11/15/2022	3/31/2028
Active	Non Resident	Agent	Casualty	11/15/2022	3/31/2028
* 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
Active	Independence American Insurance Company	524747	Agent - Casualty	6/5/2025
Active	Independence American Insurance Company	524747	Agent - Property	6/5/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allred, Anthony Troy	1102271	Agent - Health	11/28/2022	8/21/2023
Inactive	Buono, Christina	1216208	Agent - Health	11/28/2022	6/12/2023
Inactive	Carrera, Carina	1093151	Agent - Health	11/28/2022	8/21/2023
Inactive	Davis, Connie	1216061	Agent - Health	11/28/2022	8/21/2023
Inactive	Eckols, Jerry	1051479	Agent - Health	11/28/2022	8/21/2023
Inactive	Edwards, Nathel	1014274	Agent - Health	11/28/2022	8/21/2023
Inactive	Fulytar, Rachel Sue	1216872	Agent - Health	11/28/2022	8/21/2023
Inactive	Ginn, Cherilyn Kay	1093445	Agent - Health	11/28/2022	8/21/2023
Inactive	Jaurigue, Verenice	1218793	Agent - Health	11/28/2022	8/21/2023
Inactive	Kalimah, Jameel	623767	Agent - Health	11/28/2022	8/21/2023
Active	McLean, Carrie Ann	666122	Agent - Health	11/28/2022
Inactive	Minard-Rivera, Deana Marie	1091628	Agent - Health	11/28/2022	4/4/2024
Inactive	Mollohan Aguilar, Tammy Renee	1218011	Agent - Health	11/28/2022	8/21/2023
Inactive	Mora, Rajea Marie	1149977	Agent - Health	11/28/2022	8/21/2023
Inactive	Negrette, Gabriel	1222079	Agent - Health	11/28/2022	7/31/2023
Inactive	Oliver, Sanne Quatif	825655	Agent - Health	11/28/2022	8/21/2023
Inactive	Robinson, Colina A	1013190	Agent - Health	11/28/2022	8/21/2023
Inactive	Rodriguez, Paloma	1215510	Agent - Health	11/28/2022	8/21/2023
Inactive	Rubalcaba, Tanya	1221849	Agent - Health	11/28/2022	9/2/2023
Inactive	Sanchez, Felipe Jesus	785771	Agent - Health	11/28/2022	8/21/2023
Inactive	Scholta, Lanie Louise	1216556	Agent - Health	11/28/2022	5/17/2023
Inactive	Strickland, Calvin	1217417	Agent - Health	11/28/2022	8/21/2023
Active	Sullivan, David Brian	895882	Agent - Casualty	11/15/2022
Active	Sullivan, David Brian	895882	Agent - Health	11/15/2022
Active	Sullivan, David Brian	895882	Agent - Property	11/15/2022
Active	Young, Phillip Jerome	1093132	Agent - Health	11/28/2022