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	Casualty	8/15/2000		9/30/2026
Active	Resident	Agent	Property	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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	07/15/2024	09/30/2024	07/11/2024	07/11/2024	Yes

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