DEPARTMENT OF INSURANCE

Affiliations

Name	Spickard, Jack Damon	DOIID	344422	NAIC NPN	7188955

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Property	8/15/2000	9/30/2009
Inactive	Resident	Agent	General Lines	6/27/1956	8/15/2000
Inactive	Resident	Agent	Life	9/18/1967	9/30/2009
Inactive	Resident	Agent	Casualty	8/15/2000	9/30/2009
Inactive	Resident	Agent	Health	9/18/1967	9/30/2009
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	2/9/1993	3/31/1997
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	2/9/1993	3/31/1997
Inactive	Infinity Casualty Insurance Company	301280	Agent - General Lines	4/14/1986	8/5/1996
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Health	9/18/1967	3/31/1997
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Life	9/18/1967	3/31/1997
Inactive	Meridian Mutual Insurance Company	301303	Agent - Casualty	8/15/2000	6/1/2001
Inactive	Meridian Mutual Insurance Company	301303	Agent - General Lines	6/27/1956	8/15/2000
Inactive	Meridian Mutual Insurance Company	301303	Agent - Property	8/15/2000	6/1/2001
Inactive	Ohio Casualty Insurance Company	301492	Agent - General Lines	10/10/1977	3/31/1996
Inactive	Omni Insurance Company	301545	Agent - General Lines	9/25/1989	3/31/2000
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	10/1/2003	10/31/2004
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	10/1/2003	10/31/2004
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Health	3/23/1993	10/1/2003
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Life	3/23/1993	10/1/2003
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	4/14/2004	9/30/2009
Inactive	State Automobile Mutual Insurance Company	301824	Agent - General Lines	2/15/1990	8/15/2000
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	4/14/2004	9/30/2009
Inactive	Trumbull Insurance Company	300242	Agent - Casualty	8/15/2000	12/26/2001
Inactive	Trumbull Insurance Company	300242	Agent - General Lines	6/26/1998	8/15/2000
Inactive	Trumbull Insurance Company	300242	Agent - Property	8/15/2000	12/26/2001

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia of Louisville Inc.	401252	Agent - Life	5/26/1994	2/28/2003
Inactive	Acordia of Louisville Inc.	401252	Agent - Health	5/26/1994	2/28/2003
Inactive	Medlink Inc	400721	Agent - Life	1/3/1992	3/1/2004
Inactive	Medlink Inc	400721	Agent - Health	1/3/1992	3/1/2004
Inactive	Spickard Insurance Service Inc.	399837	Agent - General Lines	5/20/1991	8/15/2000
Inactive	Spickard Insurance Service Inc.	399837	Agent - Property	5/21/2004	1/19/2007
Inactive	Spickard Insurance Service Inc.	399837	Agent - Casualty	5/21/2004	1/19/2007