DEPARTMENT OF INSURANCE

Affiliations

Name	Roberts, Derrick L	DOIID	356418	NAIC NPN	7194268

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Denied	Resident	Agent	Property
Denied	Resident	Agent	Variable Life and Variable Annuities
Denied	Resident	Agent	Health
Denied	Resident	Agent	Casualty
Denied	Resident	Agent	Life
Inactive	Resident	Agent	General Lines	9/30/1996	8/15/2000
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	5/2/2006	10/20/2008
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	5/2/2006	10/20/2008
Inactive	Allstate Indemnity Company	300778	Agent - Casualty	8/15/2000	7/21/2011
Inactive	Allstate Indemnity Company	300778	Agent - General Lines	9/30/1996	8/15/2000
Inactive	Allstate Indemnity Company	300778	Agent - Property	8/15/2000	7/21/2011
Inactive	Allstate Insurance Company	300773	Agent - Casualty	8/15/2000	7/21/2011
Inactive	Allstate Insurance Company	300773	Agent - General Lines	9/30/1996	8/15/2000
Inactive	Allstate Insurance Company	300773	Agent - Property	8/15/2000	7/21/2011
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	8/12/2005	7/21/2011
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	8/12/2005	7/21/2011
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	11/26/2001	9/4/2013
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	11/26/2001	9/4/2013
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	9/23/2004	10/23/2006
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	9/23/2004	10/23/2006
Inactive	Assurity Life Insurance Company	301099	Agent - Health	3/13/2006	5/3/2012
Inactive	Assurity Life Insurance Company	301099	Agent - Life	3/13/2006	5/3/2012
Inactive	Brighthouse Life Insurance Company	301829	Agent - Health	11/14/2014	9/1/2015
Inactive	Brighthouse Life Insurance Company	301829	Agent - Life	11/14/2014	9/1/2015
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	12/2/2011	8/20/2013
Inactive	Bristol West Insurance Company	301655	Agent - Property	12/2/2011	8/20/2013
Inactive	Everlake Life Insurance Company	300873	Agent - Health	12/9/1996	7/21/2011
Inactive	Everlake Life Insurance Company	300873	Agent - Life	12/9/1996	7/21/2011
Inactive	Everlake Life Insurance Company	300873	Agent - Variable Life and Variable Annuities	5/4/2006	7/21/2011
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Casualty	2/22/2013	10/16/2015
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Property	2/22/2013	10/16/2015
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	2/22/2013	10/16/2015
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	2/22/2013	10/16/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	12/2/2011	8/20/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	12/2/2011	8/20/2013
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Life	8/14/2006	8/20/2013
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Variable Life and Variable Annuities	8/14/2006	8/20/2013
Inactive	Genworth Life Insurance Company	300623	Agent - Health	5/4/2006	12/8/2008
Inactive	Genworth Life Insurance Company	300623	Agent - Life	5/4/2006	12/8/2008
Inactive	Golden Rule Insurance Company	301943	Agent - Health	6/7/2006	5/13/2015
Inactive	Golden Rule Insurance Company	301943	Agent - Life	6/7/2006	5/13/2015
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	6/17/2011	9/8/2011
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	6/17/2011	9/8/2011
Inactive	Grange Insurance Company	300234	Agent - Casualty	6/17/2011	9/8/2011
Inactive	Grange Insurance Company	300234	Agent - Property	6/17/2011	9/8/2011
Inactive	Grange Life Insurance Company	300128	Agent - Health	6/17/2011	9/8/2011
Inactive	Grange Life Insurance Company	300128	Agent - Life	6/17/2011	9/8/2011
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	6/17/2011	9/8/2011
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Property	6/17/2011	9/8/2011
Inactive	Humana Insurance Company	301104	Agent - Health	12/3/2004	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Life	12/3/2004	9/8/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	12/3/2004	9/8/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	12/3/2004	9/8/2010
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	6/20/2006	6/7/2008
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	6/20/2006	6/7/2008
Inactive	Kentucky National Insurance Company	301625	Agent - Casualty	6/7/2011	9/9/2011
Inactive	Kentucky National Insurance Company	301625	Agent - Property	6/7/2011	9/9/2011
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	3/10/2004	7/21/2011
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	3/10/2004	7/21/2011
Inactive	Lincoln Benefit Life Company	301110	Agent - Variable Life and Variable Annuities	5/4/2006	7/21/2011
Inactive	MedAmerica Insurance Company	301568	Agent - Health	3/27/2006	12/7/2009
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Health	7/17/2014	11/14/2014
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	7/17/2014	11/14/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	3/28/2006	11/19/2008
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	3/28/2006	11/19/2008
Inactive	Motorists Mutual Insurance Company	300963	Agent - Casualty	7/13/2011	9/30/2011
Inactive	Motorists Mutual Insurance Company	300963	Agent - Property	7/13/2011	9/30/2011
Denied	Pacific Specialty Insurance Company	301846	Agent - Casualty
Denied	Pacific Specialty Insurance Company	301846	Agent - Property
Inactive	Principal Life Insurance Company	300129	Agent - Health	3/20/2006	12/2/2008
Inactive	Principal Life Insurance Company	300129	Agent - Life	3/20/2006	12/2/2008
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	8/19/2013	9/1/2015
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	8/19/2013	9/1/2015
Inactive	Pruco Life Insurance Company	300954	Agent - Health	4/30/2010	8/20/2013
Inactive	Pruco Life Insurance Company	300954	Agent - Life	4/30/2010	8/20/2013
Inactive	Pruco Life Insurance Company	300954	Agent - Variable Life and Variable Annuities	4/30/2010	8/20/2013
Inactive	Prudential Insurance Company of America	300784	Agent - Health	3/28/2006	8/20/2013
Inactive	Prudential Insurance Company of America	300784	Agent - Life	3/28/2006	8/20/2013
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	6/17/2011	9/8/2011
Inactive	Trustgard Insurance Company	300104	Agent - Property	6/17/2011	9/8/2011
Inactive	United Financial Casualty Company	301886	Agent - Casualty	8/19/2013	9/1/2015
Inactive	United Financial Casualty Company	301886	Agent - Property	8/19/2013	9/1/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Heritage Insurance Agency Inc.	400711	Agent - Life	6/3/2011	9/30/2011
Inactive	Heritage Insurance Agency Inc.	400711	Agent - Health	6/3/2011	9/30/2011
Inactive	Heritage Insurance Agency Inc.	400711	Agent - Property	6/3/2011	9/30/2011
Inactive	Heritage Insurance Agency Inc.	400711	Agent - Casualty	6/3/2011	9/30/2011
Inactive	R.L. Roberts, Inc.	543963	Agent - Life	1/10/2002	6/1/2011
Inactive	R.L. Roberts, Inc.	543963	Agent - Health	1/10/2002	6/1/2011
Inactive	R.L. Roberts, Inc.	543963	Agent - Property	1/10/2002	6/1/2011
Inactive	R.L. Roberts, Inc.	543963	Agent - Casualty	1/10/2002	6/1/2011
Inactive	T.R.U.S.T. Insurance Agency	762764	Agent - Life	9/7/2011	3/31/2013
Inactive	T.R.U.S.T. Insurance Agency	762764	Agent - Health	9/7/2011	3/31/2013
Inactive	T.R.U.S.T. Insurance Agency	762764	Agent - Property	9/7/2011	3/31/2013
Inactive	T.R.U.S.T. Insurance Agency	762764	Agent - Casualty	9/7/2011	3/31/2013