DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Acrisure Partner Group LLC	DOIID	1246693	NAIC NPN	20555814

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	12/13/2022		3/31/2026
Active	Non Resident	Agent	Casualty	12/13/2022		3/31/2026
Active	Non Resident	Agent	Life	12/13/2022		3/31/2026
Active	Non Resident	Agent	Health	12/13/2022		3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	1/6/2023		3/31/2026
* 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	Employers Assurance Company	300120	Agent - Casualty	3/15/2024
Active	Employers Compensation Insurance Company	797885	Agent - Casualty	3/15/2024
Active	Employers Preferred Insurance Company	520656	Agent - Casualty	3/15/2024
Active	Reliance Standard Life Insurance Company	300584	Agent - Health	9/14/2023
Active	Reliance Standard Life Insurance Company	300584	Agent - Life	9/14/2023
Active	United Concordia Insurance Company	903543	Agent - Health	5/9/2024

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Kolenda, Courtney Lynne	1022910	Agent - Casualty	12/13/2022
Active	Kolenda, Courtney Lynne	1022910	Agent - Health	12/13/2022
Active	Kolenda, Courtney Lynne	1022910	Agent - Life	12/13/2022
Active	Kolenda, Courtney Lynne	1022910	Agent - Property	12/13/2022
Active	Kolenda, Courtney Lynne	1022910	Surplus Lines Broker - Not Applicable	1/6/2023