DEPARTMENT OF INSURANCE

Affiliations

Name	Dolack, Brian A	DOIID	386374	NAIC NPN	1466229

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Variable Life and Variable Annuities	7/22/2003		3/31/2027
Active	Resident	Agent	Casualty	8/15/2000		3/31/2027
Active	Resident	Agent	Health	11/9/1989		3/31/2027
Active	Resident	Agent	Property	8/15/2000		3/31/2027
Active	Resident	Agent	Life	11/9/1989		3/31/2027
Inactive	Resident	Agent	General Lines	12/11/1989	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	Allstate Indemnity Company	300778	Agent - Casualty	8/15/2000	7/28/2012
Inactive	Allstate Indemnity Company	300778	Agent - General Lines	12/11/1989	8/15/2000
Inactive	Allstate Indemnity Company	300778	Agent - Property	8/15/2000	7/28/2012
Inactive	Allstate Insurance Company	300773	Agent - Casualty	8/15/2000	7/28/2012
Inactive	Allstate Insurance Company	300773	Agent - General Lines	12/11/1989	8/15/2000
Inactive	Allstate Insurance Company	300773	Agent - Property	8/15/2000	7/28/2012
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	8/12/2005	7/28/2012
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	8/12/2005	7/28/2012
Active	American Economy Insurance Company	300315	Agent - Casualty	11/9/2019
Active	American Economy Insurance Company	300315	Agent - Property	11/9/2019
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	12/5/2000	8/17/2012
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	12/5/2000	8/17/2012
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	2/6/2019
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Property	2/6/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	11/18/2015	11/14/2021
Inactive	American Modern Select Insurance Company	581481	Agent - Property	11/18/2015	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	5/10/2016	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	5/10/2016	11/14/2021
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	7/6/2012	12/7/2017
Inactive	Bristol West Insurance Company	301655	Agent - Property	7/6/2012	12/7/2017
Inactive	Celtic Insurance Company	300877	Agent - Health	3/18/1992	3/31/1997
Inactive	Celtic Insurance Company	300877	Agent - Life	3/18/1992	3/31/1997
Active	Encompass Insurance Company	300188	Agent - Casualty	5/28/2024
Active	Encompass Insurance Company	300188	Agent - Property	5/28/2024
Inactive	Everlake Life Insurance Company	300873	Agent - Health	11/9/1989	7/28/2012
Inactive	Everlake Life Insurance Company	300873	Agent - Life	11/9/1989	7/28/2012
Inactive	Everlake Life Insurance Company	300873	Agent - Variable Life and Variable Annuities	7/22/2003	8/8/2007
Inactive	Farmers Casualty Insurance Company	301616	Agent - Casualty	9/11/2012	12/30/2013
Inactive	Farmers Casualty Insurance Company	301616	Agent - Property	9/11/2012	12/30/2013
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	9/11/2012	7/17/2018
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	9/11/2012	7/17/2018
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	7/6/2012
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	7/6/2012
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Life	8/14/2006	8/9/2007
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Variable Life and Variable Annuities	8/14/2006	8/9/2007
Active	Integon Indemnity Corporation	300674	Agent - Casualty	4/30/2022
Active	Integon Indemnity Corporation	300674	Agent - Property	4/30/2022
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	5/19/1998	7/28/2012
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	4/2/1996	7/28/2012
Inactive	Lincoln Benefit Life Company	301110	Agent - Variable Life and Variable Annuities	7/22/2003	8/8/2007
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	7/25/2012
Active	SAFECO Insurance Company of America	300159	Agent - Property	7/25/2012
Active	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	7/25/2012
Active	SAFECO Insurance Company of Illinois	301350	Agent - Property	7/25/2012
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	6/20/2018	12/16/2021
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	6/20/2018	12/16/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Dolack Insurance Agency Inc.	510813	Agent - Life
Denied	Dolack Insurance Agency Inc.	510813	Agent - Health
Inactive	Dolack Insurance Agency Inc.	510813	Agent - General Lines	7/13/2000	8/15/2000
Active	Dolack Insurance Agency Inc.	510813	Agent - Property	8/15/2000
Active	Dolack Insurance Agency Inc.	510813	Agent - Casualty	8/15/2000