DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Dombrowski, Haley	DOIID	1298534	NAIC NPN	16688359

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	9/14/2023		9/30/2027
Active	Non Resident	Agent	Casualty	9/14/2023		9/30/2027
* 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	Farmers Insurance Exchange	300336	Agent - Casualty	9/27/2023	5/5/2026
Inactive	Farmers Insurance Exchange	300336	Agent - Property	9/27/2023	5/5/2026
Inactive	Midvale Indemnity Company	300292	Agent - Casualty	10/31/2023	2/24/2026
Inactive	Midvale Indemnity Company	300292	Agent - Property	10/31/2023	2/24/2026

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fx Insurance Agency, LLC	646184	Agent - Casualty	9/27/2023	5/5/2026
Inactive	Fx Insurance Agency, LLC	646184	Agent - Property	9/27/2023	5/5/2026
Inactive	Kraft Lake Insurance Agency, Inc.	658511	Agent - Casualty	9/27/2023	5/5/2026
Inactive	Kraft Lake Insurance Agency, Inc.	658511	Agent - Property	9/27/2023	5/5/2026