DEPARTMENT OF INSURANCE

Affiliations

Name	Provine, Gwen S	DOIID	377970	NAIC NPN	7203698

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	4/3/1992		9/30/2026
Active	Resident	Agent	Property	8/15/2000		9/30/2026
Active	Resident	Agent	Casualty	8/15/2000		9/30/2026
Active	Resident	Agent	Life	4/3/1992		9/30/2026
Inactive	Resident	Agent	General Lines	1/14/2000	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	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	9/12/2005	12/20/2023
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Property	9/12/2005	12/20/2023
Inactive	American Select Insurance Company	301229	Agent - Casualty	8/15/2000	9/1/2009
Inactive	American Select Insurance Company	301229	Agent - General Lines	2/3/2000	8/15/2000
Inactive	American Select Insurance Company	301229	Agent - Property	8/15/2000	9/1/2009
Inactive	Ansur America Insurance Company	520667	Agent - Casualty	5/19/2016	10/17/2024
Inactive	Ansur America Insurance Company	520667	Agent - Property	5/19/2016	10/17/2024
Inactive	Assurance Company of America	300432	Agent - Casualty	1/31/2002	3/22/2010
Inactive	Assurance Company of America	300432	Agent - Property	1/31/2002	3/22/2010
Inactive	Frankenmuth Insurance Company	301481	Agent - Casualty	5/19/2016	10/17/2024
Inactive	Frankenmuth Insurance Company	301481	Agent - Property	5/19/2016	10/17/2024
Inactive	Glatfelter Insurance Company	301640	Agent - Casualty	1/31/2002	11/30/2007
Inactive	Glatfelter Insurance Company	301640	Agent - Property	1/31/2002	11/30/2007
Inactive	Grange Life Insurance Company	300128	Agent - Health	11/2/1993	12/22/2016
Inactive	Grange Life Insurance Company	300128	Agent - Life	11/2/1993	12/22/2016
Active	Great American Alliance Insurance Company	301247	Agent - Casualty	9/28/2022
Active	Great American Alliance Insurance Company	301247	Agent - Property	9/28/2022
Active	Great American Assurance Company	300327	Agent - Casualty	9/28/2022
Active	Great American Assurance Company	300327	Agent - Property	9/28/2022
Active	Great American Insurance Company	301586	Agent - Casualty	9/28/2022
Active	Great American Insurance Company	301586	Agent - Property	9/28/2022
Active	Great American Insurance Company of New York	301897	Agent - Casualty	9/28/2022
Active	Great American Insurance Company of New York	301897	Agent - Property	9/28/2022
Active	Great American Spirit Insurance Company	300233	Agent - Casualty	9/28/2022
Active	Great American Spirit Insurance Company	300233	Agent - Property	9/28/2022
Inactive	Guarantee Life Insurance Company	301560	Agent - Health	4/3/1992	9/8/2000
Inactive	Guarantee Life Insurance Company	301560	Agent - Life	4/3/1992	9/8/2000
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	9/22/2007	11/5/2008
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	9/22/2007	11/5/2008
Inactive	Hartford Casualty Insurance Company	301332	Agent - Casualty	9/22/2007	11/7/2008
Inactive	Hartford Casualty Insurance Company	301332	Agent - Property	9/22/2007	11/7/2008
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	9/22/2007	11/7/2008
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	9/22/2007	11/7/2008
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	9/22/2007	11/7/2008
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	9/22/2007	11/7/2008
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	9/22/2007	11/7/2008
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	9/22/2007	11/7/2008
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	9/8/2000	7/2/2007
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	9/8/2000	7/2/2007
Inactive	Kentucky National Insurance Company	301625	Agent - Casualty	4/24/2002	7/10/2003
Inactive	Kentucky National Insurance Company	301625	Agent - Property	4/24/2002	7/10/2003
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	7/2/2007	3/25/2009
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	7/2/2007	3/25/2009
Inactive	Maryland Casualty Company	301719	Agent - Casualty	1/31/2002	3/22/2010
Inactive	Maryland Casualty Company	301719	Agent - Property	1/31/2002	3/22/2010
Inactive	Northern Insurance Company of New York	301317	Agent - Casualty	1/31/2002	3/22/2010
Inactive	Northern Insurance Company of New York	301317	Agent - Property	1/31/2002	3/22/2010
Inactive	Ohio Farmers Insurance Company	301667	Agent - Casualty	8/15/2000	9/1/2009
Inactive	Ohio Farmers Insurance Company	301667	Agent - General Lines	1/14/2000	8/15/2000
Inactive	Ohio Farmers Insurance Company	301667	Agent - Property	8/15/2000	9/1/2009
Inactive	Old Guard Insurance Company	533854	Agent - Casualty	6/3/2021	6/14/2021
Inactive	Old Guard Insurance Company	533854	Agent - Property	6/3/2021	6/14/2021
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	9/22/2007	11/7/2008
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	9/22/2007	11/7/2008
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	9/22/2007	11/7/2008
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	9/22/2007	11/7/2008
Inactive	Westfield Champion Insurance Company	1054839	Agent - Casualty	6/3/2021	6/14/2021
Inactive	Westfield Champion Insurance Company	1054839	Agent - Property	6/3/2021	6/14/2021
Inactive	Westfield Insurance Company	301950	Agent - Casualty	8/15/2000	9/5/2024
Inactive	Westfield Insurance Company	301950	Agent - General Lines	2/3/2000	8/15/2000
Inactive	Westfield Insurance Company	301950	Agent - Property	8/15/2000	9/5/2024
Inactive	Westfield National Insurance Company	301036	Agent - Casualty	8/15/2000	9/1/2009
Inactive	Westfield National Insurance Company	301036	Agent - General Lines	2/3/2000	8/15/2000
Inactive	Westfield National Insurance Company	301036	Agent - Property	8/15/2000	9/1/2009
Inactive	Westfield Premier Insurance Company	1055055	Agent - Casualty	6/3/2021	6/14/2021
Inactive	Westfield Premier Insurance Company	1055055	Agent - Property	6/3/2021	6/14/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Casualty	6/3/2021	6/14/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Property	6/3/2021	6/14/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Casualty	6/3/2021	6/14/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Property	6/3/2021	6/14/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Assuredpartners NL, LLC	762387	Agent - Life
Denied	Assuredpartners NL, LLC	762387	Agent - Health
Inactive	Assuredpartners NL, LLC	762387	Agent - Property	3/31/2017	9/6/2024
Inactive	Assuredpartners NL, LLC	762387	Agent - Casualty	3/31/2017	9/6/2024
Inactive	Cornelius & Wilson Inc.	400039	Agent - Life	2/15/2012	12/22/2016
Inactive	Cornelius & Wilson Inc.	400039	Agent - Health	2/15/2012	12/22/2016
Inactive	Cornelius & Wilson Inc.	400039	Agent - Property	2/15/2012	3/31/2018
Inactive	Cornelius & Wilson Inc.	400039	Agent - Casualty	2/15/2012	3/31/2018
Inactive	King Ins Services Inc	398432	Agent - Life	9/14/1998	12/22/2016
Inactive	King Ins Services Inc	398432	Agent - Health	9/14/1998	12/22/2016
Inactive	King Ins Services Inc	398432	Agent - Property	6/30/2003	3/31/2019
Inactive	King Ins Services Inc	398432	Agent - Casualty	6/30/2003	3/31/2019