DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Century Workers' Compensation Agency, Inc.	DOIID	502120	NAIC NPN	3204373

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	8/15/2000	5/31/2004
Inactive	Non Resident	Agent	General Lines	2/10/2000	8/15/2000
Inactive	Non Resident	Agent	Casualty	8/15/2000	5/31/2004
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Evergreen National Indemnity Company	300146	Agent - Casualty	8/15/2000	5/31/2004
Inactive	Evergreen National Indemnity Company	300146	Agent - General Lines	2/10/2000	8/15/2000
Inactive	Evergreen National Indemnity Company	300146	Agent - Property	8/15/2000	5/31/2004

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Prickett, Michael A	332811	Agent - Casualty	8/15/2000	5/31/2004
Inactive	Prickett, Michael A	332811	Agent - General Lines	2/10/2000	8/15/2000
Inactive	Prickett, Michael A	332811	Agent - Property	8/15/2000	5/31/2004