DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Bonita M	DOIID	506234	NAIC NPN	3619203

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Adjuster	Independent	5/5/2000	12/31/2006
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Sedgwick Claims Management Service Inc	401194	Adjuster - Independent	11/7/2005	12/31/2006
Inactive	Travelers Property Casualty Insurance Company	301508	Adjuster - Independent	5/5/2000	12/31/2006