DEPARTMENT OF INSURANCE
Affiliations
NameICC Ins Agency IncDOIID400522NAIC NPN953593
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentVariable Life and Variable Annuities3/3/20091/20/2017 
InactiveNon ResidentAgentHealth3/3/20091/20/2017 
InactiveNon ResidentAgentLife3/3/20091/20/2017 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAllianz Life Insurance Company of North America301791Agent - Health1/14/20111/20/2017
InactiveAllianz Life Insurance Company of North America301791Agent - Life1/14/20111/20/2017
InactiveAllianz Life Insurance Company of North America301791Agent - Variable Life and Variable Annuities1/14/20111/20/2017
InactiveAmerican Enterprise Life Insurance Company300262Agent - Life2/3/200512/31/2006
InactiveAmerican Enterprise Life Insurance Company300262Agent - Variable Life and Variable Annuities2/3/200512/31/2006
InactiveAmerican National Insurance Company301861Agent - Life7/20/200111/19/2008
InactiveAmeritas Life Insurance Corporation300126Agent - Life2/4/201311/15/2016
InactiveAmeritas Life Insurance Corporation300126Agent - Variable Life and Variable Annuities2/4/201311/15/2016
InactiveAmeritas Variable Life Insurance Company300665Agent - Life9/5/20005/1/2007
InactiveAmeritas Variable Life Insurance Company300665Agent - Variable Life and Variable Annuities5/4/20055/1/2007
InactiveAthene Annuity & Life Assurance Company301798Agent - Life1/22/20138/13/2015
InactiveBanner Life Insurance Company301696Agent - Life10/7/20101/20/2017
InactiveBrighthouse Life Insurance Company301829Agent - Life3/23/20091/20/2017
InactiveBrighthouse Life Insurance Company301829Agent - Variable Life and Variable Annuities3/23/20091/20/2017
InactiveC.M. Life Insurance Company301335Agent - Life5/8/200111/19/2008
InactiveC.M. Life Insurance Company301335Agent - Variable Life and Variable Annuities5/31/200111/19/2008
InactiveCommonwealth Annuity and Life Insurance Company300798Agent - Life3/20/200011/19/2008
InactiveConnecticut General Life Insurance Company301333Agent - Life7/18/19963/21/2001
InactiveDelaware Life Insurance Company301256Agent - Life6/25/199811/19/2008
InactiveDelaware Life Insurance Company301256Agent - Variable Life and Variable Annuities5/31/200111/19/2008
InactiveEagle Life Insurance Company701261Agent - Life12/17/20151/20/2017
InactiveEquiTrust Life Insurance Company502870Agent - Life3/17/20091/20/2017
InactiveEquitable Financial Life Insurance Company300808Agent - Life10/1/199711/19/2008
InactiveEquitable Financial Life Insurance Company300808Agent - Variable Life and Variable Annuities5/31/200111/19/2008
InactiveEquitable Financial Life Insurance Company of America301772Agent - Life4/17/200311/19/2008
InactiveEquitable Financial Life Insurance Company of America301772Agent - Variable Life and Variable Annuities4/17/200311/19/2008
InactiveEquitable Financial Life and Annuity Company301833Agent - Life6/3/19992/3/2003
InactiveEverlake Life Insurance Company300873Agent - Life4/20/200911/27/2013
InactiveEverlake Life Insurance Company300873Agent - Variable Life and Variable Annuities4/20/200911/27/2013
InactiveForethought Life Insurance Company301407Agent - Health4/11/20131/20/2017
InactiveForethought Life Insurance Company301407Agent - Life4/11/20131/20/2017
InactiveForethought Life Insurance Company301407Agent - Variable Life and Variable Annuities4/11/20131/20/2017
InactiveFortitude Life Insurance & Annuity Company301503Agent - Life10/21/20091/20/2017
InactiveFortitude Life Insurance & Annuity Company301503Agent - Variable Life and Variable Annuities10/21/20091/20/2017
InactiveGeneral American Life Insurance Company300280Agent - Life3/23/200911/14/2009
InactiveGenworth Life and Annuity Insurance Company301276Agent - Life4/28/200912/7/2012
InactiveGenworth Life and Annuity Insurance Company301276Agent - Variable Life and Variable Annuities4/28/200912/7/2012
InactiveGlenbrook Life and Annuity Company301384Agent - Life4/7/19971/1/2005
InactiveING Insurance Company of America301507Agent - Life4/23/199912/31/2005
InactiveJackson National Life Insurance Company300486Agent - Life3/3/201110/10/2016
InactiveJackson National Life Insurance Company300486Agent - Variable Life and Variable Annuities3/3/201110/10/2016
InactiveJefferson National Life Insurance Company300258Agent - Life12/14/19986/8/2006
InactiveJohn Hancock Life Insurance Company300821Agent - Life4/8/200511/19/2008
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Life1/22/200211/19/2008
InactiveLincoln Benefit Life Company301110Agent - Health7/14/20107/14/2014
InactiveLincoln Benefit Life Company301110Agent - Life7/14/20107/14/2014
InactiveLincoln Benefit Life Company301110Agent - Variable Life and Variable Annuities7/14/20107/14/2014
InactiveLincoln National Life Insurance Company (The)301382Agent - Life2/8/201010/19/2016
InactiveLincoln National Life Insurance Company (The)301382Agent - Variable Life and Variable Annuities2/8/201010/19/2016
InactiveMML Bay State Life Insurance Company301198Agent - Life5/8/200111/19/2008
InactiveMML Bay State Life Insurance Company301198Agent - Variable Life and Variable Annuities5/31/200111/19/2008
InactiveManufacturers Life Insurance Company of North America301899Agent - Life10/28/19971/22/2002
InactiveMassMutual Ascend Life Insurance Company300320Agent - Life10/22/20131/20/2017
InactiveMassachusetts Mutual Life Insurance Company300445Agent - Life5/8/200111/19/2008
InactiveMassachusetts Mutual Life Insurance Company300445Agent - Variable Life and Variable Annuities5/31/200111/19/2008
InactiveMetLife Investors Insurance Company301872Agent - Life3/23/200911/14/2014
InactiveMetLife Investors Insurance Company301872Agent - Variable Life and Variable Annuities3/23/200911/14/2014
InactiveMetLife Investors USA Insurance Company300845Agent - Life3/23/200911/14/2014
InactiveMetLife Investors USA Insurance Company300845Agent - Variable Life and Variable Annuities3/23/200911/14/2014
InactiveMetLife Life and Annuity Company of Connecticut301593Agent - Life6/1/200312/7/2007
InactiveMetLife Life and Annuity Company of Connecticut301593Agent - Variable Life and Variable Annuities6/1/200312/7/2007
InactiveMetropolitan Life Insurance Company301948Agent - Life3/23/20091/20/2017
InactiveMetropolitan Life Insurance Company301948Agent - Variable Life and Variable Annuities3/23/20091/20/2017
InactiveNationwide Life Insurance Company300495Agent - Health1/29/201312/13/2016
InactiveNationwide Life Insurance Company300495Agent - Life1/29/201312/13/2016
InactiveNationwide Life Insurance Company300495Agent - Variable Life and Variable Annuities1/29/201312/13/2016
InactiveNew England Life Insurance Company300343Agent - Life3/23/200912/10/2009
InactiveNew York Life Insurance and Annuity Corporation300726Agent - Life8/17/20091/12/2017
InactiveNew York Life Insurance and Annuity Corporation300726Agent - Variable Life and Variable Annuities8/17/20091/12/2017
InactivePacific Life Insurance Company301848Agent - Life6/26/201310/25/2016
InactivePacific Life Insurance Company301848Agent - Variable Life and Variable Annuities6/26/201310/25/2016
InactivePenn Insurance and Annuity Company300712Agent - Life3/20/20095/14/2013
InactivePenn Insurance and Annuity Company300712Agent - Variable Life and Variable Annuities3/20/20095/14/2013
InactivePenn Mutual Life Insurance Company301394Agent - Life3/20/20095/14/2013
InactivePenn Mutual Life Insurance Company301394Agent - Variable Life and Variable Annuities3/20/20095/14/2013
InactivePrincipal Life Insurance Company300129Agent - Life10/24/200611/19/2008
InactivePrincipal Life Insurance Company300129Agent - Variable Life and Variable Annuities10/24/200611/19/2008
InactivePruco Life Insurance Company300954Agent - Life10/21/20091/20/2017
InactivePruco Life Insurance Company300954Agent - Variable Life and Variable Annuities10/21/20091/20/2017
InactivePrudential Insurance Company of America300784Agent - Life10/21/20091/20/2017
InactivePrudential Insurance Company of America300784Agent - Variable Life and Variable Annuities10/21/20091/20/2017
InactiveReassure America Life Insurance Company301902Agent - Life5/3/19999/16/2004
InactiveReliance Standard Life Insurance Company300584Agent - Health3/25/20091/20/2017
InactiveReliance Standard Life Insurance Company300584Agent - Life3/25/20091/20/2017
InactiveRiverSource Life Insurance Company301952Agent - Life12/31/200611/19/2008
InactiveRiverSource Life Insurance Company301952Agent - Variable Life and Variable Annuities12/31/200611/19/2008
InactiveSecurity Benefit Life Insurance Company300583Agent - Life9/19/200011/19/2008
InactiveSun Life Assurance Company of Canada301811Agent - Life11/11/200411/19/2008
InactiveSunAmerica Annuity and Life Assurance Company301930Agent - Life6/2/200611/19/2008
InactiveSunAmerica Annuity and Life Assurance Company301930Agent - Variable Life and Variable Annuities6/2/200611/19/2008
InactiveTalcott Resolution Life Insurance Company301759Agent - Life7/24/201212/25/2016
InactiveTalcott Resolution Life Insurance Company301759Agent - Variable Life and Variable Annuities7/24/201212/25/2016
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Life7/24/201212/25/2016
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Variable Life and Variable Annuities7/24/201212/25/2016
InactiveTransamerica Life Insurance Company300571Agent - Life4/15/20091/20/2017
InactiveTransamerica Life Insurance Company300571Agent - Variable Life and Variable Annuities4/15/20091/20/2017
InactiveU.S. Financial Life Insurance Company301812Agent - Life5/31/20069/18/2007
InactiveUnited of Omaha Life Insurance Company300156Agent - Life5/1/200011/19/2008
InactiveVenerable Insurance and Annuity Company301006Agent - Health6/24/20091/20/2017
InactiveVenerable Insurance and Annuity Company301006Agent - Life6/24/20091/20/2017
InactiveVenerable Insurance and Annuity Company301006Agent - Variable Life and Variable Annuities6/24/20091/20/2017
InactiveVoya Retirement Insurance and Annuity Company300643Agent - Life4/23/199911/19/2008
InactiveVoya Retirement Insurance and Annuity Company300643Agent - Variable Life and Variable Annuities10/24/200811/19/2008
InactiveWestern National Life Insurance Company300461Agent - Life12/10/19987/17/2007
InactiveWestern Reserve Life Assurance Company of Ohio300760Agent - Life11/15/200212/28/2006
InactiveWestern Reserve Life Assurance Company of Ohio300760Agent - Variable Life and Variable Annuities11/15/200212/28/2006
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAcciavatti, Peter F 688130Agent - Health3/3/200910/18/2016
InactiveAcciavatti, Peter F 688130Agent - Life3/3/200910/18/2016
InactiveAcciavatti, Peter F 688130Agent - Variable Life and Variable Annuities3/3/200910/18/2016
DeniedCharles, Theodore Everett 318630Agent - Life  
DeniedCharles, Theodore Everett 318630Agent - Variable Life and Variable Annuities  
InactiveSmiley, Stanley Robert 575944Agent - Health6/21/20161/20/2017
InactiveSmiley, Stanley Robert 575944Agent - Life6/21/20161/20/2017
InactiveSmiley, Stanley Robert 575944Agent - Variable Life and Variable Annuities6/21/20161/20/2017

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