DEPARTMENT OF INSURANCE

Affiliations

Name	Selfridge, Gary William	DOIID	320985	NAIC NPN	1030044

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Casualty	8/15/2000	5/31/2020
Inactive	Non Resident	Agent	Health	11/12/1991	5/31/2020
Inactive	Non Resident	Agent	General Lines	6/29/1988	8/15/2000
Inactive	Non Resident	Agent	Property	8/15/2000	5/31/2020
Inactive	Non Resident	Agent	Life	11/12/1991	5/31/2020
* 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	AIG Assurance Company	300897	Agent - Casualty	3/29/2005	7/24/2010
Inactive	AIG Assurance Company	300897	Agent - Property	3/29/2005	7/24/2010
Inactive	Aetna Health Inc.	300694	Agent - Health	4/10/2003	12/31/2007
Inactive	Aetna Health Inc.	300694	Agent - Life	4/10/2003	12/31/2007
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/31/2007	12/8/2011
Inactive	Aetna Health Inc. (PA)	660717	Agent - Life	12/31/2007	9/21/2010
Inactive	Aetna Life Insurance Company	301140	Agent - Health	4/10/2003	12/8/2011
Inactive	Aetna Life Insurance Company	301140	Agent - Life	4/10/2003	12/8/2011
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	1/10/2011	2/10/2020
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	1/10/2011	2/10/2020
Inactive	American United Life Insurance Company	300498	Agent - Health	4/1/2003	5/31/2020
Inactive	American United Life Insurance Company	300498	Agent - Life	4/1/2003	5/31/2020
Inactive	Assurance Company of America	300432	Agent - Casualty	8/15/2000	12/17/2014
Inactive	Assurance Company of America	300432	Agent - General Lines	11/4/1996	8/15/2000
Inactive	Assurance Company of America	300432	Agent - Property	8/15/2000	12/17/2014
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	4/9/2004	5/31/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	4/9/2004	5/31/2020
Inactive	Blackboard Insurance Company	301640	Agent - Casualty	8/15/2000	11/30/2007
Inactive	Blackboard Insurance Company	301640	Agent - General Lines	11/4/1996	8/15/2000
Inactive	Blackboard Insurance Company	301640	Agent - Property	8/15/2000	11/30/2007
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	12/14/2009	12/7/2017
Inactive	Bristol West Insurance Company	301655	Agent - Property	12/14/2009	12/7/2017
Inactive	Cincinnati Insurance Company	301298	Agent - Casualty	9/4/2008	3/12/2010
Inactive	Cincinnati Insurance Company	301298	Agent - Property	9/4/2008	3/12/2010
Inactive	CompBenefits Insurance Company	301864	Agent - Life	3/24/2003	12/30/2004
Inactive	Conseco Insurance Company	301202	Agent - Life	11/29/1994	12/18/1998
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	7/6/2012
Inactive	First Colony Life Insurance Company	301179	Agent - Health	8/10/2004	1/1/2007
Inactive	First Colony Life Insurance Company	301179	Agent - Life	8/10/2004	1/1/2007
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/21/2011	5/31/2020
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/21/2011	5/31/2020
Inactive	General Casualty Company of Wisconsin	300930	Agent - Casualty	8/15/2000	11/28/2018
Inactive	General Casualty Company of Wisconsin	300930	Agent - General Lines	10/2/1996	8/15/2000
Inactive	General Casualty Company of Wisconsin	300930	Agent - Property	8/15/2000	11/28/2018
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Health	1/1/2007	12/4/2007
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	1/1/2007	12/4/2007
Inactive	Golden Rule Insurance Company	301943	Agent - Health	6/7/1994	3/31/1997
Inactive	Golden Rule Insurance Company	301943	Agent - Life	6/7/1994	3/31/1997
Inactive	Granite State Insurance Company	300818	Agent - Casualty	6/29/2005	7/24/2010
Inactive	Granite State Insurance Company	300818	Agent - Property	6/29/2005	7/24/2010
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	4/9/2004	5/31/2020
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	4/9/2004	5/31/2020
Inactive	Hallmark National Insurance Company	300494	Agent - Casualty	12/22/2004	4/19/2005
Inactive	Hallmark National Insurance Company	300494	Agent - Property	12/22/2004	4/19/2005
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	3/16/2006	11/5/2008
Inactive	Hartford Casualty Insurance Company	301332	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Hartford Casualty Insurance Company	301332	Agent - Property	3/16/2006	11/5/2008
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	3/16/2006	11/5/2008
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	3/16/2006	11/5/2008
Inactive	Hartford Steam Boiler Inspection and Insurance Company	300799	Agent - Casualty	8/15/2000	12/21/2006
Inactive	Hartford Steam Boiler Inspection and Insurance Company	300799	Agent - General Lines	9/14/1998	8/15/2000
Inactive	Hartford Steam Boiler Inspection and Insurance Company	300799	Agent - Property	8/15/2000	12/21/2006
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	3/16/2006	11/5/2008
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	5/2/2003	7/6/2012
Inactive	Humana Insurance Company	301104	Agent - Health	9/10/2007	7/6/2012
Inactive	Humana Insurance Company	301104	Agent - Life	9/10/2007	7/6/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/10/2007	7/6/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/10/2007	7/6/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Health	9/10/2007	2/23/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	9/10/2007	2/23/2012
Inactive	Illinois National Insurance Company	301367	Agent - Casualty	1/8/2007	7/24/2010
Inactive	Illinois National Insurance Company	301367	Agent - Property	1/8/2007	7/24/2010
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	4/25/2003	12/12/2006
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	4/25/2003	12/12/2006
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Life	5/2/2003	12/12/2006
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/11/2008	7/6/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/11/2008	7/6/2012
Inactive	Maryland Casualty Company	301719	Agent - Casualty	8/15/2000	12/17/2014
Inactive	Maryland Casualty Company	301719	Agent - General Lines	11/4/1996	8/15/2000
Inactive	Maryland Casualty Company	301719	Agent - Property	8/15/2000	12/17/2014
Inactive	Midland National Life Insurance Company	300923	Agent - Health	2/19/1998	3/10/2005
Inactive	Midland National Life Insurance Company	300923	Agent - Life	2/19/1998	10/16/2001
Inactive	Nippon Life Insurance Company of America	300446	Agent - Health	4/14/2003	2/7/2013
Inactive	Nippon Life Insurance Company of America	300446	Agent - Life	4/14/2003	2/7/2013
Inactive	Northern Insurance Company of New York	301317	Agent - Casualty	8/15/2000	12/17/2014
Inactive	Northern Insurance Company of New York	301317	Agent - General Lines	11/4/1996	8/15/2000
Inactive	Northern Insurance Company of New York	301317	Agent - Property	8/15/2000	12/17/2014
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	5/17/2001	7/3/2001
Inactive	Ohio Casualty Insurance Company	301492	Agent - General Lines	6/29/1988	8/15/2000
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	5/17/2001	7/3/2001
Inactive	Ohio Farmers Insurance Company	301667	Agent - Casualty	8/15/2000	6/23/2003
Inactive	Ohio Farmers Insurance Company	301667	Agent - General Lines	9/30/1993	8/15/2000
Inactive	Ohio Farmers Insurance Company	301667	Agent - Property	8/15/2000	6/23/2003
Inactive	Omni Indemnity Company	301456	Agent - Casualty	5/16/2006	10/8/2009
Inactive	Omni Indemnity Company	301456	Agent - Property	5/16/2006	10/8/2009
Inactive	Omni Insurance Company	301545	Agent - Casualty	5/16/2006	10/27/2009
Inactive	Omni Insurance Company	301545	Agent - Property	5/16/2006	10/27/2009
Inactive	PAFCO General Insurance Company	301645	Agent - General Lines	10/20/1993	3/31/1996
Inactive	Plymouth Rock Assurance Preferred Corporation	301834	Agent - Casualty	9/10/2007	7/24/2010
Inactive	Plymouth Rock Assurance Preferred Corporation	301834	Agent - Property	9/10/2007	7/24/2010
Inactive	Principal Life Insurance Company	300129	Agent - Health	1/28/1999	11/25/2009
Inactive	Principal Life Insurance Company	300129	Agent - Life	1/28/1999	11/25/2009
Inactive	Reassure America Life Insurance Company	301902	Agent - Health	8/24/1995	9/20/2004
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	8/24/1995	9/20/2004
Inactive	Regent Insurance Company	300411	Agent - Casualty	8/15/2000	11/28/2018
Inactive	Regent Insurance Company	300411	Agent - General Lines	8/13/1998	8/15/2000
Inactive	Regent Insurance Company	300411	Agent - Property	8/15/2000	11/28/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	3/5/2015	10/19/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	3/5/2015	10/19/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	3/5/2015	10/19/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	3/5/2015	10/19/2018
Inactive	Selective Insurance Company of America	500018	Agent - Casualty	12/4/2012	7/20/2020
Inactive	Selective Insurance Company of America	500018	Agent - Property	12/4/2012	7/20/2020
Inactive	Selective Insurance Company of South Carolina	500012	Agent - Casualty	12/4/2012	7/20/2020
Inactive	Selective Insurance Company of South Carolina	500012	Agent - Property	12/4/2012	7/20/2020
Inactive	Selective Insurance Company of the Southeast	300381	Agent - Casualty	12/4/2012	7/20/2020
Inactive	Selective Insurance Company of the Southeast	300381	Agent - Property	12/4/2012	7/20/2020
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	3/16/2006	11/5/2008
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - Casualty	8/15/2000	4/19/2005
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - General Lines	2/29/1996	8/15/2000
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - Property	8/15/2000	4/19/2005
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	8/15/2000	4/19/2005
Inactive	State Automobile Mutual Insurance Company	301824	Agent - General Lines	2/29/1996	8/15/2000
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	8/15/2000	4/19/2005
Inactive	Sussex Insurance Company	301970	Agent - Casualty	1/19/2005	2/5/2014
Inactive	Sussex Insurance Company	301970	Agent - Property	1/19/2005	2/5/2014
Inactive	Time Insurance Company	300683	Agent - Health	1/29/2004	12/15/2004
Inactive	Time Insurance Company	300683	Agent - Life	1/29/2004	12/15/2004
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	3/16/2006	11/5/2008
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	3/16/2006	11/5/2008
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	12/9/2005	12/14/2009
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	12/9/2005	12/14/2009
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	12/9/2005	12/14/2009
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	12/9/2005	12/14/2009
Inactive	West American Insurance Company	301112	Agent - General Lines	6/29/1988	8/15/2000
Inactive	Western Surety Company	300283	Agent - Casualty	8/15/2000	5/6/2002
Inactive	Western Surety Company	300283	Agent - General Lines	3/28/1989	8/15/2000
Inactive	Westfield Insurance Company	301950	Agent - Casualty	8/15/2000	8/15/2003
Inactive	Westfield Insurance Company	301950	Agent - General Lines	9/30/1993	8/15/2000
Inactive	Westfield Insurance Company	301950	Agent - Property	8/15/2000	8/15/2003
Inactive	Westfield National Insurance Company	301036	Agent - Casualty	8/15/2000	6/23/2003
Inactive	Westfield National Insurance Company	301036	Agent - General Lines	9/30/1993	8/15/2000
Inactive	Westfield National Insurance Company	301036	Agent - Property	8/15/2000	6/23/2003
Inactive	Wilcac Life Insurance Company	301573	Agent - Health	8/24/1995	3/31/1997
Inactive	Wilcac Life Insurance Company	301573	Agent - Life	8/24/1995	3/31/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	4/7/1999	2/28/2003
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	4/7/1999	2/28/2003
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/9/2013	5/31/2020
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/9/2013	5/31/2020
Inactive	Medlink Inc	400721	Agent - Life	9/18/2014	5/31/2020
Inactive	Medlink Inc	400721	Agent - Health	9/18/2014	5/31/2020
Inactive	Selfridge & Associates Inc.	399957	Agent - Life	11/12/1991	3/31/2020
Inactive	Selfridge & Associates Inc.	399957	Agent - Health	11/12/1991	3/31/2020
Inactive	Selfridge & Associates Inc.	399957	Agent - Property	8/15/2000	3/31/2020
Inactive	Selfridge & Associates Inc.	399957	Agent - Casualty	8/15/2000	3/31/2020