DEPARTMENT OF INSURANCE

Affiliations

Name	Forystek, Roger F.	DOIID	308894	NAIC NPN	1483344

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Casualty	8/15/2000	8/31/2019
Inactive	Non Resident	Agent	General Lines	4/29/1999	8/15/2000
Inactive	Non Resident	Agent	Life	12/4/2000	8/31/2019
Inactive	Non Resident	Agent	Property	8/15/2000	8/31/2019
Inactive	Non Resident	Agent	Health	12/4/2000	8/31/2019
* 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	AMCO Insurance Company	300204	Agent - Casualty	1/21/2015	3/12/2018
Inactive	AMCO Insurance Company	300204	Agent - Property	1/21/2015	3/12/2018
Inactive	Allied Property and Casualty Insurance Company	300279	Agent - Casualty	1/21/2015	3/12/2018
Inactive	Allied Property and Casualty Insurance Company	300279	Agent - Property	1/21/2015	3/12/2018
Inactive	American Fire and Casualty Company	300567	Agent - Casualty	8/24/2011	8/31/2019
Inactive	American Fire and Casualty Company	300567	Agent - Property	8/24/2011	8/31/2019
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - General Lines	3/6/2000	8/15/2000
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	8/15/2000	8/4/2008
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - General Lines	1/13/2000	8/15/2000
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	8/15/2000	8/4/2008
Inactive	Cincinnati Life Insurance Company (The)	300601	Agent - Health	12/4/2000	8/10/2005
Inactive	Cincinnati Life Insurance Company (The)	300601	Agent - Life	12/4/2000	8/10/2005
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	8/15/2000	8/31/2019
Inactive	Consolidated Insurance Company	300943	Agent - General Lines	5/28/1999	8/15/2000
Inactive	Consolidated Insurance Company	300943	Agent - Property	8/15/2000	8/31/2019
Inactive	Depositors Insurance Company	301634	Agent - Casualty	1/21/2015	3/12/2018
Inactive	Depositors Insurance Company	301634	Agent - Property	1/21/2015	3/12/2018
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Life	2/9/2001	6/30/2003
Inactive	First National Insurance Company of America	301690	Agent - Casualty	10/7/2008	8/31/2019
Inactive	First National Insurance Company of America	301690	Agent - Property	10/7/2008	8/31/2019
Inactive	General Insurance Company of America	300261	Agent - Casualty	10/7/2008	8/31/2019
Inactive	General Insurance Company of America	300261	Agent - Property	10/7/2008	8/31/2019
Inactive	Indiana Insurance Company	301909	Agent - Casualty	8/15/2000	8/31/2019
Inactive	Indiana Insurance Company	301909	Agent - General Lines	5/28/1999	8/15/2000
Inactive	Indiana Insurance Company	301909	Agent - Property	8/15/2000	8/31/2019
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	7/7/2015	8/31/2019
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	7/7/2015	8/31/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	8/15/2000	8/31/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - General Lines	5/28/1999	8/15/2000
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	8/15/2000	8/31/2019
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	11/7/2007	8/31/2019
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	11/7/2007	8/31/2019
Inactive	Ohio Security Insurance Company	300622	Agent - Casualty	8/24/2011	8/31/2019
Inactive	Ohio Security Insurance Company	300622	Agent - Property	8/24/2011	8/31/2019
Inactive	Peerless Insurance Company	301910	Agent - Casualty	8/15/2000	8/31/2019
Inactive	Peerless Insurance Company	301910	Agent - General Lines	4/29/1999	8/15/2000
Inactive	Peerless Insurance Company	301910	Agent - Property	8/15/2000	8/31/2019
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	10/7/2008	8/31/2019
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	10/7/2008	8/31/2019
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	10/7/2008	8/31/2019
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	10/7/2008	8/31/2019
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	5/30/2016	8/15/2017
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	5/30/2016	8/15/2017
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Standard Fire Insurance Company (The)	301068	Agent - General Lines	3/6/2000	8/15/2000
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	8/15/2000	8/4/2008
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	8/15/2000	8/4/2008
Inactive	The Phoenix Insurance Company	301502	Agent - General Lines	1/13/2000	8/15/2000
Inactive	The Phoenix Insurance Company	301502	Agent - Property	8/15/2000	8/4/2008
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Travelers Indemnity Company (The)	301855	Agent - General Lines	1/13/2000	8/15/2000
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	8/15/2000	8/4/2008
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - General Lines	1/13/2000	8/15/2000
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	8/15/2000	8/4/2008
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - General Lines	1/13/2000	8/15/2000
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	8/15/2000	8/4/2008
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	8/15/2000	8/4/2008
Inactive	Travelers Property Casualty Company of America	301649	Agent - General Lines	1/13/2000	8/15/2000
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	8/15/2000	8/4/2008
Inactive	West American Insurance Company	301112	Agent - Casualty	8/24/2011	8/31/2019
Inactive	West American Insurance Company	301112	Agent - Property	8/24/2011	8/31/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Assuredpartners Of Colorado LLC	848142	Agent - Life
Denied	Assuredpartners Of Colorado LLC	848142	Agent - Health
Inactive	Assuredpartners Of Colorado LLC	848142	Agent - Property	8/13/2014	8/31/2019
Inactive	Assuredpartners Of Colorado LLC	848142	Agent - Casualty	8/13/2014	8/31/2019
Inactive	HUB International Midwest Limited	398717	Agent - Life	1/12/2004	8/1/2005
Inactive	HUB International Midwest Limited	398717	Agent - Health	1/12/2004	8/1/2005
Inactive	HUB International Midwest Limited	398717	Agent - Property	1/12/2004	8/1/2005
Inactive	HUB International Midwest Limited	398717	Agent - Casualty	1/12/2004	8/1/2005
Denied	Hub International Ins Services Inc	609910	Agent - Life
Denied	Hub International Ins Services Inc	609910	Agent - Health
Inactive	Hub International Ins Services Inc	609910	Agent - Property	7/17/2009	8/31/2019
Inactive	Hub International Ins Services Inc	609910	Agent - Casualty	7/17/2009	8/31/2019
Inactive	Hub International Southwest Agency Limited	401335	Agent - Life	3/28/2005	8/10/2005
Inactive	Hub International Southwest Agency Limited	401335	Agent - Health	3/28/2005	8/10/2005
Inactive	Hub International Southwest Agency Limited	401335	Agent - Property	3/28/2005	1/23/2009
Inactive	Hub International Southwest Agency Limited	401335	Agent - Casualty	3/28/2005	1/23/2009
Inactive	Wright Group Inc	734435	Agent - Life	8/13/2010	3/31/2016
Inactive	Wright Group Inc	734435	Agent - Health	8/13/2010	3/31/2016
Inactive	Wright Group Inc	734435	Agent - Property	8/13/2010	3/31/2016
Inactive	Wright Group Inc	734435	Agent - Casualty	8/13/2010	3/31/2016