DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Gomez, Carmen Milagros	DOIID	1299630	NAIC NPN	3601796

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	9/20/2023		2/28/2025
Active	Non Resident	Agent	Health	9/20/2023		2/28/2025
* 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	Chesapeake Life Insurance Company (The)	301017	Agent - Health	10/31/2023
Active	Chesapeake Life Insurance Company (The)	301017	Agent - Life	10/31/2023
Active	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	10/31/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Broad Street Brokerage Insurance Agency, LLC	540067	Agent - Life	3/20/2024
Active	Broad Street Brokerage Insurance Agency, LLC	540067	Agent - Health	3/20/2024
Active	Hola Seguros, Llc	1047606	Agent - Health	12/19/2023