DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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		2/28/2027
Active	Non Resident	Agent	Health	9/20/2023		2/28/2027
* 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	12/15/2024	02/28/2025	01/30/2025	01/30/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	10/31/2023	1/6/2025
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	10/31/2023	1/6/2025
Active	Golden Rule Insurance Company	301943	Agent - Health	11/15/2024
Active	Golden Rule Insurance Company	301943	Agent - Life	11/15/2024
Inactive	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	10/31/2023	10/30/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Broad Street Brokerage Insurance Agency, LLC	540067	Agent - Life	3/20/2024	11/8/2024
Inactive	Broad Street Brokerage Insurance Agency, LLC	540067	Agent - Health	3/20/2024	11/8/2024
Active	Hola Seguros, Llc	1047606	Agent - Health	12/19/2023