DEPARTMENT OF INSURANCE

Affiliations

Name	Gossard, Keith Allen	DOIID	362491	NAIC NPN	234892

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Casualty	8/15/2000	2/28/2009
Inactive	Non Resident	Agent	Health	9/23/1994	2/28/2009
Inactive	Non Resident	Agent	Health Maintenance Organization	8/7/1998	3/1/2001
Inactive	Non Resident	Agent	Property	8/15/2000	2/28/2009
Inactive	Non Resident	Agent	Life	9/23/1994	2/28/2009
Inactive	Non Resident	Agent	General Lines	4/19/1990	8/15/2000
* 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	Accident Fund General Insurance Company	626282	Agent - Casualty	6/5/2007	2/28/2009
Inactive	Accident Fund Insurance Company of America	518734	Agent - Casualty	6/5/2007	2/28/2009
Inactive	Accident Fund National Insurance Company	626286	Agent - Casualty	6/5/2007	2/28/2009
Inactive	Auto-Owners Insurance Company	301480	Agent - Casualty	4/29/2002	2/10/2004
Inactive	Auto-Owners Insurance Company	301480	Agent - Property	4/29/2002	2/10/2004
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	6/24/2008	2/28/2009
Inactive	CompBenefits Insurance Company	301864	Agent - Health	6/24/2008	2/28/2009
Inactive	CompBenefits Insurance Company	301864	Agent - Life	6/24/2008	2/28/2009
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	9/23/1994	12/26/1998
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	9/23/1994	12/26/1998
Inactive	FCCI Insurance Company	557454	Agent - Casualty	12/11/2003	12/22/2005
Inactive	FCCI Insurance Company	557454	Agent - Property	12/11/2003	12/22/2005
Inactive	Federal Insurance Company	301144	Agent - Casualty	8/15/2000	2/28/2009
Inactive	Federal Insurance Company	301144	Agent - General Lines	12/28/1995	8/15/2000
Inactive	Federal Insurance Company	301144	Agent - Property	8/15/2000	2/28/2009
Inactive	Great Northern Insurance Company	301107	Agent - Casualty	8/12/2002	2/28/2009
Inactive	Great Northern Insurance Company	301107	Agent - Property	8/12/2002	2/28/2009
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/1/2001	2/28/2009
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	8/7/1998	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	7/13/1998	2/28/2009
Inactive	Humana Insurance Company	301104	Agent - Life	7/13/1998	2/28/2009
Inactive	Merchants Bonding Company (Mutual)	300170	Agent - Casualty	2/2/2006	2/28/2009
Inactive	Monroe Guaranty Insurance Company	300771	Agent - Casualty	9/9/2002	12/22/2005
Inactive	Monroe Guaranty Insurance Company	300771	Agent - Property	9/9/2002	12/22/2005
Inactive	National Trust Insurance Company	300367	Agent - Casualty	9/9/2002	12/22/2005
Inactive	National Trust Insurance Company	300367	Agent - Property	9/9/2002	12/22/2005
Inactive	Ohio Farmers Insurance Company	301667	Agent - Casualty	8/15/2000	2/28/2009
Inactive	Ohio Farmers Insurance Company	301667	Agent - General Lines	7/31/1997	8/15/2000
Inactive	Ohio Farmers Insurance Company	301667	Agent - Property	8/15/2000	2/28/2009
Inactive	Owners Insurance Company	300796	Agent - Casualty	12/20/2002	2/12/2004
Inactive	Owners Insurance Company	300796	Agent - Property	12/20/2002	2/12/2004
Inactive	Reliance Insurance Company	300785	Agent - Casualty	8/15/2000	6/5/2001
Inactive	Reliance Insurance Company	300785	Agent - General Lines	4/19/1990	8/15/2000
Inactive	Reliance Insurance Company	300785	Agent - Property	8/15/2000	6/5/2001
Inactive	Westfield Insurance Company	301950	Agent - Casualty	8/15/2000	2/28/2009
Inactive	Westfield Insurance Company	301950	Agent - General Lines	5/1/2000	8/15/2000
Inactive	Westfield Insurance Company	301950	Agent - Property	8/15/2000	2/28/2009
Inactive	Westfield National Insurance Company	301036	Agent - Casualty	1/4/2008	2/28/2009
Inactive	Westfield National Insurance Company	301036	Agent - General Lines	7/31/1997	3/31/1998
Inactive	Westfield National Insurance Company	301036	Agent - Property	1/4/2008	2/28/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Stoner Ins Inc	556331	Agent - Life	8/27/2002	2/28/2009
Inactive	Stoner Ins Inc	556331	Agent - Health	8/27/2002	2/28/2009
Denied	Stoner Ins Inc	556331	Agent - Property
Denied	Stoner Ins Inc	556331	Agent - Casualty