DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Co-Ordinated Benefit Plans Llc	DOIID	397781	NAIC NPN	2257434

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	1/24/2007		3/31/2025
Active	Non Resident	Agent	Casualty	1/4/2013		3/31/2025
Active	Non Resident	Agent	Property	1/4/2013		3/31/2025
Active	Non Resident	Agent	Health	1/2/2013		3/31/2025
Active	Non Resident	Agent	Life	1/2/2013		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	Nationwide Mutual Insurance Company	301749	Agent - Casualty	5/8/2018
Active	Nationwide Mutual Insurance Company	301749	Agent - Property	5/8/2018
Active	United States Fire Insurance Company	582240	Agent - Casualty	8/2/2023
Active	United States Fire Insurance Company	582240	Agent - Health	8/2/2023
Active	United States Fire Insurance Company	582240	Agent - Property	8/2/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Crist, Jennifer Michele	929080	Agent - Casualty	4/26/2017	3/17/2020
Denied	Crist, Jennifer Michele	929080	Agent - Health
Denied	Crist, Jennifer Michele	929080	Agent - Life
Inactive	Crist, Jennifer Michele	929080	Agent - Property	4/26/2017	3/17/2020
Active	Leys, Kevin H	536253	Administrator - Not Applicable	9/24/2020
Active	Leys, Kevin H	536253	Agent - Casualty	1/4/2013
Active	Leys, Kevin H	536253	Agent - Health	1/2/2013
Active	Leys, Kevin H	536253	Agent - Life	1/2/2013
Active	Leys, Kevin H	536253	Agent - Property	1/4/2013
Inactive	Rice, Laura Therese	639880	Administrator - Not Applicable	1/24/2007	1/31/2010
Inactive	Sivak, Rebecca L	1049104	Administrator - Not Applicable	1/23/2020	9/24/2020
Inactive	Whalen, Suzanne Elizabeth	700020	Administrator - Not Applicable	3/16/2009	1/23/2020