DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Juanita Yvonne	DOIID	316123	NAIC NPN	690195

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	1/12/2007	6/14/2010
Inactive	Non Resident	Agent	Health	6/17/1998	6/14/2010
Inactive	Non Resident	Agent	Casualty	1/12/2007	6/14/2010
Inactive	Non Resident	Agent	Life	6/17/1998	6/14/2010
* 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	ACE American Insurance Company	300625	Agent - Casualty	2/10/2007	2/13/2010
Inactive	ACE American Insurance Company	300625	Agent - Property	2/10/2007	2/13/2010
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Health	1/28/2000	4/17/2003
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Life	1/28/2000	4/17/2003
Inactive	American Security Insurance Company	300901	Agent - Health	9/27/2001	11/18/2002
Inactive	Combined Insurance Company of America	301472	Agent - Health	6/17/1998	6/27/2001
Inactive	Combined Insurance Company of America	301472	Agent - Life	6/17/1998	6/27/2001
Inactive	Everlake Life Insurance Company	300873	Agent - Health	5/30/2000	12/16/2003
Inactive	Everlake Life Insurance Company	300873	Agent - Life	5/30/2000	12/16/2003
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	12/27/2006	6/14/2010
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	12/27/2006	6/14/2010
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	4/24/2006	9/5/2008
Inactive	Humana Insurance Company	301104	Agent - Health	4/24/2006	9/5/2008
Inactive	Humana Insurance Company	301104	Agent - Life	4/24/2006	9/5/2008
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	8/22/2006	6/14/2010
Inactive	Sears Life Insurance Company	300218	Agent - Health	7/17/2000	12/19/2002
Inactive	Sears Life Insurance Company	300218	Agent - Life	7/17/2000	12/19/2002
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	12/19/2006	2/13/2010
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	12/19/2006	2/13/2010
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	12/19/2006	2/13/2010
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	12/19/2006	2/13/2010
Inactive	Union Fidelity Life Insurance Company	301136	Agent - Health	6/17/1998	9/3/2002
Inactive	Union Fidelity Life Insurance Company	301136	Agent - Life	6/17/1998	9/3/2002
Inactive	Union Security Insurance Company	301844	Agent - Health	2/27/2001	4/17/2003
Inactive	Union Security Insurance Company	301844	Agent - Life	2/27/2001	4/17/2003
Inactive	Union Security Life Insurance Company	300903	Agent - Health	9/27/2001	11/18/2002
Inactive	Union Security Life Insurance Company	300903	Agent - Life	9/27/2001	11/18/2002
Inactive	Wilcac Life Insurance Company	301573	Agent - Health	5/8/2001	12/30/2004
Inactive	Wilcac Life Insurance Company	301573	Agent - Life	5/8/2001	12/2/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	TeleSpectrum, Inc	512199	Agent - Life	7/31/2000	5/2/2003
Inactive	TeleSpectrum, Inc	512199	Agent - Health	7/31/2000	5/2/2003
Inactive	Telespectrum Inc	604670	Agent - Life	3/8/2007	3/31/2009
Inactive	Telespectrum Inc	604670	Agent - Health	3/8/2007	3/31/2009
Inactive	e-Telequote Insurance, Inc.	687772	Agent - Life	12/8/2008	1/27/2010
Inactive	e-Telequote Insurance, Inc.	687772	Agent - Health	12/8/2008	1/27/2010
Inactive	e-Telequote Insurance, Inc.	687772	Agent - Property	12/8/2008	1/27/2010
Inactive	e-Telequote Insurance, Inc.	687772	Agent - Casualty	12/8/2008	1/27/2010