DEPARTMENT OF INSURANCE

Affiliations

Name	Gallagher Affinity Insurance Services, Inc.	DOIID	397758	NAIC NPN	1499729

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	12/30/1987	3/31/2025
Active	Non Resident	Agent	Life	4/19/2004	3/31/2025
Active	Non Resident	Agent	Health	4/19/2004	3/31/2025
Active	Non Resident	Agent	Casualty	5/13/2014	3/31/2025
Active	Non Resident	Agent	Property	5/13/2014	3/31/2025
* 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
Administrator	01/15/2025	03/31/2025
Agent	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE American Insurance Company	300625	Agent - Health	3/6/2016
Active	American Contractors Indemnity Company	536843	Agent - Casualty	10/3/2023
Inactive	American Fire and Casualty Company	300567	Agent - Casualty	12/4/2023	3/29/2024
Inactive	American Fire and Casualty Company	300567	Agent - Property	12/4/2023	3/29/2024
Inactive	American Guarantee and Liability Insurance Company	301216	Agent - Casualty	7/22/2010	6/15/2011
Active	American Guarantee and Liability Insurance Company	301216	Agent - Health	5/3/2024
Inactive	American Guarantee and Liability Insurance Company	301216	Agent - Property	7/22/2010	6/15/2011
Inactive	American States Insurance Company	301230	Agent - Casualty	12/4/2023	3/29/2024
Inactive	American States Insurance Company	301230	Agent - Property	12/4/2023	3/29/2024
Inactive	American Zurich Insurance Company	300592	Agent - Casualty	11/18/2011	4/4/2014
Active	American Zurich Insurance Company	300592	Agent - Health	5/3/2024
Inactive	American Zurich Insurance Company	300592	Agent - Property	11/18/2011	4/4/2014
Active	Arch Indemnity Insurance Company	301459	Agent - Casualty	8/1/2023
Active	Arch Indemnity Insurance Company	301459	Agent - Property	8/1/2023
Active	Arch Insurance Company	300688	Agent - Casualty	8/1/2023
Active	Arch Insurance Company	300688	Agent - Property	8/1/2023
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Health	3/11/2009	12/10/2014
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	3/11/2009	12/10/2014
Active	Capitol Indemnity Corporation	301030	Agent - Casualty	3/29/2024
Active	CorePointe Insurance Company	300406	Agent - Casualty	12/20/2023
Active	CorePointe Insurance Company	300406	Agent - Property	12/20/2023
Active	Developers Surety and Indemnity Company	516432	Agent - Casualty	12/20/2023
Active	Employers Assurance Company	300120	Agent - Casualty	5/29/2024
Active	Employers Compensation Insurance Company	797885	Agent - Casualty	5/29/2024
Active	Employers Preferred Insurance Company	520656	Agent - Casualty	5/29/2024
Active	Federal Insurance Company	301144	Agent - Health	4/8/2014
Inactive	General Insurance Company of America	300261	Agent - Casualty	12/4/2023	3/29/2024
Inactive	General Insurance Company of America	300261	Agent - Property	12/4/2023	3/29/2024
Active	General Security National Insurance Company	301484	Agent - Casualty	10/30/2023
Active	General Security National Insurance Company	301484	Agent - Health	10/30/2023
Active	General Security National Insurance Company	301484	Agent - Property	10/30/2023
Inactive	Gerber Life Insurance Company	300529	Agent - Health	2/23/2011	3/4/2014
Inactive	Gerber Life Insurance Company	300529	Agent - Life	2/23/2011	3/4/2014
Active	Great American Insurance Company	301586	Agent - Casualty	9/14/2023
Active	Great American Insurance Company	301586	Agent - Property	9/14/2023
Active	HDI Global Insurance Company	676678	Agent - Casualty	11/13/2023
Active	HDI Global Insurance Company	676678	Agent - Property	11/13/2023
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	4/12/2024
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	4/12/2024
Active	Hudson Insurance Company	523144	Agent - Casualty	2/9/2024
Active	Hudson Insurance Company	523144	Agent - Property	2/9/2024
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	12/4/2023
Active	Liberty Mutual Insurance Company	301159	Agent - Property	12/4/2023
Active	Merchants Bonding Company (Mutual)	300170	Agent - Casualty	4/25/2024
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	10/12/2004
Active	New York Life Insurance Company	300431	Agent - Health	5/7/2024
Active	New York Life Insurance Company	300431	Agent - Life	5/7/2024
Active	Occidental Life Insurance Company of North Carolina	301185	Agent - Life	11/20/2023
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	12/4/2023
Active	Ohio Casualty Insurance Company	301492	Agent - Property	12/4/2023
Inactive	Ohio Security Insurance Company	300622	Agent - Casualty	12/4/2023	3/29/2024
Inactive	Ohio Security Insurance Company	300622	Agent - Property	12/4/2023	3/29/2024
Active	Peerless Insurance Company	301910	Agent - Casualty	12/4/2023
Active	Peerless Insurance Company	301910	Agent - Property	12/4/2023
Active	Platte River Insurance Company	301089	Agent - Casualty	3/29/2024
Active	Principal Life Insurance Company	300129	Agent - Health	9/15/2023
Active	Principal Life Insurance Company	300129	Agent - Life	9/15/2023
Inactive	Security Life Insurance Company of America	300936	Agent - Health	11/30/2005	12/2/2010
Inactive	Security Life Insurance Company of America	300936	Agent - Life	11/30/2005	12/2/2010
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	8/22/2005	10/1/2015
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	8/22/2005	10/1/2015
Inactive	Symetra Life Insurance Company	301691	Agent - Health	1/6/2006	12/6/2007
Inactive	Symetra Life Insurance Company	301691	Agent - Life	1/6/2006	12/6/2007
Inactive	Tesla Insurance Company	300337	Agent - Casualty	7/27/2004	2/3/2009
Inactive	Tesla Insurance Company	300337	Agent - Property	7/27/2004	2/3/2009
Active	The Gray Casualty & Surety Company	661857	Agent - Casualty	4/11/2024
Inactive	Time Insurance Company	300683	Agent - Health	1/28/2005	4/12/2011
Inactive	Time Insurance Company	300683	Agent - Life	1/28/2005	4/12/2011
Active	Transamerica Life Insurance Company	300571	Agent - Health	10/1/2015
Active	Transamerica Life Insurance Company	300571	Agent - Life	10/1/2015
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	4/29/2004	10/1/2020
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	4/29/2004	10/1/2020
Active	U.S. Specialty Insurance Company	300186	Agent - Casualty	10/3/2023
Inactive	Virginia Surety Company, Inc.	301022	Agent - Casualty	12/21/2010	4/4/2014
Inactive	Virginia Surety Company, Inc.	301022	Agent - Property	12/21/2010	4/4/2014
Active	Washington National Insurance Company	300587	Agent - Health	3/12/2024
Active	Washington National Insurance Company	300587	Agent - Life	3/12/2024
Inactive	West American Insurance Company	301112	Agent - Casualty	12/4/2023	3/29/2024
Inactive	West American Insurance Company	301112	Agent - Property	12/4/2023	3/29/2024
Active	Western Surety Company	300283	Agent - Casualty	1/25/2024
Inactive	Zurich American Insurance Company	301121	Agent - Casualty	7/22/2010	4/4/2014
Active	Zurich American Insurance Company	301121	Agent - Health	2/22/2024
Inactive	Zurich American Insurance Company	301121	Agent - Property	7/22/2010	4/4/2014
Inactive	Zurich American Insurance Company of Illinois	301805	Agent - Casualty	7/22/2010	6/15/2011
Active	Zurich American Insurance Company of Illinois	301805	Agent - Health	5/3/2024
Inactive	Zurich American Insurance Company of Illinois	301805	Agent - Property	7/22/2010	6/15/2011

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Applin, Sheree Leanne	826280	Agent - Health	10/4/2023
Active	Applin, Sheree Leanne	826280	Agent - Life	10/4/2023
Active	Baran, Edward	393313	Agent - Casualty	4/9/2024
Active	Baran, Edward	393313	Agent - Property	4/9/2024
Active	Belpedio, William	1095341	Agent - Casualty	11/6/2023
Active	Belpedio, William	1095341	Agent - Property	11/6/2023
Active	Block, Joseph	1067110	Agent - Casualty	4/9/2024
Pending	Block, Joseph	1067110	Agent - Health
Pending	Block, Joseph	1067110	Agent - Life
Active	Block, Joseph	1067110	Agent - Property	4/9/2024
Active	Breckenridge, John Calvin	670892	Agent - Health	4/9/2024
Active	Breckenridge, John Calvin	670892	Agent - Life	4/9/2024
Active	Bridge, James	1334836	Agent - Health	5/10/2024
Pending	Bridge, James	1334836	Agent - Life
Active	Buckley, Daniel	876113	Agent - Casualty	11/6/2023
Active	Buckley, Daniel	876113	Agent - Health	11/6/2023
Active	Buckley, Daniel	876113	Agent - Property	11/6/2023
Active	Buckshnis, Joseph	1168191	Agent - Casualty	4/9/2024
Active	Buckshnis, Joseph	1168191	Agent - Property	4/9/2024
Active	Buseman, Christopher Ryan	909559	Agent - Casualty	4/9/2024
Active	Buseman, Christopher Ryan	909559	Agent - Property	4/9/2024
Active	Cardoso, Michael	995855	Agent - Health	9/27/2023
Active	Conley, Brett	1064395	Agent - Casualty	4/9/2024
Active	Conley, Brett	1064395	Agent - Health	4/9/2024
Pending	Conley, Brett	1064395	Agent - Life
Active	Conley, Brett	1064395	Agent - Property	4/9/2024
Inactive	Coverdell, Paul Douglas	378112	Administrator - Not Applicable	12/30/1987	8/17/2000
Active	Cronen, Bryan C	389734	Agent - Health	4/9/2024
Active	Cronen, Bryan C	389734	Agent - Life	4/9/2024
Inactive	Di Benedetto, Vincent E	682989	Administrator - Not Applicable	6/18/2008	8/8/2022
Active	Di Benedetto, Vincent E	682989	Agent - Casualty	5/13/2014
Active	Di Benedetto, Vincent E	682989	Agent - Health	3/21/2014
Active	Di Benedetto, Vincent E	682989	Agent - Life	3/21/2014
Active	Di Benedetto, Vincent E	682989	Agent - Property	5/13/2014
Active	Dioses, Marisol	868863	Agent - Health	4/9/2024
Active	Dioses, Marisol	868863	Agent - Life	4/9/2024
Active	Divito, Michael	1240081	Agent - Casualty	4/9/2024
Active	Divito, Michael	1240081	Agent - Health	4/9/2024
Pending	Divito, Michael	1240081	Agent - Life
Active	Divito, Michael	1240081	Agent - Property	4/9/2024
Denied	Doering, Thomas Michael	1098785	Agent - Health
Denied	Doering, Thomas Michael	1098785	Agent - Life
Active	Garvin, Kevin Patrick	1221187	Administrator - Not Applicable	8/8/2022
Denied	Gould, Thomas	979140	Agent - Health
Denied	Gould, Thomas	979140	Agent - Life
Active	Hawksworth, Alita	1046921	Agent - Casualty	4/15/2024
Active	Hawksworth, Alita	1046921	Agent - Property	4/15/2024
Active	Hohenberger, Ronnie Dee	727963	Agent - Health	9/27/2023
Active	Hohenberger, Ronnie Dee	727963	Agent - Life	9/27/2023
Active	Jenkins, Jason Lee	581960	Agent - Casualty	5/2/2024
Active	Jenkins, Jason Lee	581960	Agent - Property	5/2/2024
Active	Jensen, Samantha Joy	1054027	Agent - Casualty	4/15/2024
Active	Jensen, Samantha Joy	1054027	Agent - Property	4/15/2024
Active	Jensen, Thomas	1055895	Agent - Casualty	4/16/2024
Active	Jensen, Thomas	1055895	Agent - Property	4/16/2024
Inactive	Joseph, Jeremiah	1333822	Agent - Casualty	4/18/2024	4/26/2024
Inactive	Joseph, Jeremiah	1333822	Agent - Property	4/18/2024	4/26/2024
Active	King, Angela	791012	Agent - Health	4/16/2024
Active	Kissner, Jodi Lynn	1072363	Agent - Health	4/16/2024
Active	Kissner, Jodi Lynn	1072363	Agent - Life	4/16/2024
Active	Klewsaat, Theresa Ann	1172584	Agent - Health	11/6/2023
Active	Klewsaat, Theresa Ann	1172584	Agent - Life	11/6/2023
Inactive	Kolker, Steven Charles	681954	Administrator - Not Applicable	7/1/2009	11/30/2015
Inactive	Kolker, Steven Charles	681954	Agent - Casualty	5/8/2009	4/4/2014
Inactive	Kolker, Steven Charles	681954	Agent - Health	9/3/2008	4/4/2014
Inactive	Kolker, Steven Charles	681954	Agent - Life	9/3/2008	4/4/2014
Inactive	Kolker, Steven Charles	681954	Agent - Property	5/8/2009	4/4/2014
Active	Kretsinger, Clay	1173103	Agent - Health	4/15/2024
Active	Kretsinger, Clay	1173103	Agent - Life	4/15/2024
Denied	Locke, Rebecca Jeanne	1197711	Agent - Health
Denied	Locke, Rebecca Jeanne	1197711	Agent - Life
Denied	Matthews, John A	911154	Agent - Health
Denied	Matthews, John A	911154	Agent - Life
Active	Mcdonald, Cory	1044924	Agent - Casualty	4/15/2024
Active	Mcdonald, Cory	1044924	Agent - Property	4/15/2024
Active	Mcshane, Amelia	1186115	Agent - Casualty	4/16/2024
Active	Mcshane, Amelia	1186115	Agent - Property	4/16/2024
Active	Moore, Michael	560206	Agent - Casualty	6/27/2024
Active	Moore, Michael	560206	Agent - Property	6/27/2024
Active	Murphy, Michael Eugene	564982	Agent - Health	11/6/2023
Active	Murphy, Michael Eugene	564982	Agent - Life	11/6/2023
Active	Nelson, Brian	862551	Agent - Casualty	4/16/2024
Active	Nelson, Brian	862551	Agent - Property	4/16/2024
Inactive	Owens, Michael Lewis	359320	Administrator - Not Applicable	4/29/1999	11/10/2008
Inactive	Owens, Michael Lewis	359320	Agent - Casualty	7/27/2004	11/10/2008
Inactive	Owens, Michael Lewis	359320	Agent - Health	4/19/2004	11/10/2008
Inactive	Owens, Michael Lewis	359320	Agent - Life	4/19/2004	11/10/2008
Inactive	Owens, Michael Lewis	359320	Agent - Property	7/27/2004	11/10/2008
Denied	Owens, Ronald Lee	1114545	Agent - Health
Denied	Owens, Ronald Lee	1114545	Agent - Life
Active	Pescosolido, Carrie	1017498	Agent - Casualty	4/16/2024
Active	Pescosolido, Carrie	1017498	Agent - Property	4/16/2024
Active	Peters, Joseph	1078376	Agent - Casualty	4/16/2024
Active	Peters, Joseph	1078376	Agent - Property	4/16/2024
Active	Pitonyak, Lauren Marie	783177	Agent - Casualty	4/11/2024
Active	Pitonyak, Lauren Marie	783177	Agent - Property	4/11/2024
Denied	Polansky, Scott	1070725	Agent - Health
Inactive	Rogers, Jason	898952	Agent - Casualty	4/11/2024	6/20/2024
Inactive	Rogers, Jason	898952	Agent - Property	4/11/2024	6/20/2024
Active	Ryan, John E	367068	Agent - Health	11/6/2023
Active	Ryan, John E	367068	Agent - Life	11/6/2023
Active	Sandonato, Dean	1119999	Agent - Health	11/6/2023
Active	Shike, Steve	1058259	Agent - Casualty	4/11/2024
Active	Shike, Steve	1058259	Agent - Property	4/11/2024
Active	Stein, Sara	701969	Agent - Casualty	4/11/2024
Pending	Stein, Sara	701969	Agent - Health
Pending	Stein, Sara	701969	Agent - Life
Active	Stein, Sara	701969	Agent - Property	4/11/2024
Active	Tietz, Brandon Michael	763616	Agent - Casualty	4/11/2024
Active	Tietz, Brandon Michael	763616	Agent - Property	4/11/2024
Active	Turner, Mark Peter	815867	Agent - Casualty	4/11/2024
Active	Turner, Mark Peter	815867	Agent - Property	4/11/2024
Active	Valle, Jason	1282983	Agent - Casualty	4/11/2024
Active	Valle, Jason	1282983	Agent - Property	4/11/2024
Active	Vincent, Jolie	811676	Agent - Casualty	4/11/2024
Active	Vincent, Jolie	811676	Agent - Health	4/11/2024
Pending	Vincent, Jolie	811676	Agent - Life
Active	Vincent, Jolie	811676	Agent - Property	4/11/2024
Active	Walterick, James	1064253	Agent - Health	11/6/2023
Active	Walterick, James	1064253	Agent - Life	11/6/2023
Active	West, Kenneth D	745395	Agent - Health	4/11/2024
Active	West, Kenneth D	745395	Agent - Life	4/11/2024