DEPARTMENT OF INSURANCE

Affiliations

Name	Hazle, Jacob Shane	DOIID	516567	NAIC NPN	7215338

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Casualty	12/10/2012		9/30/2024
Active	Resident	Agent	Health	12/10/2012		9/30/2024
Active	Resident	Agent	Life	12/10/2012		9/30/2024
Active	Resident	Agent	Property	12/10/2012		9/30/2024
Inactive	Resident	Agent	Variable Life and Variable Annuities	5/31/2001	10/1/2012
* 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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	2/10/2014
Active	ACUITY, A Mutual Insurance Company	300095	Agent - Property	2/10/2014
Inactive	Aegis Security Insurance Company	300492	Agent - Casualty	12/1/2014	11/4/2022
Inactive	Aegis Security Insurance Company	300492	Agent - Property	12/1/2014	11/4/2022
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/9/2009	7/30/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Health	12/9/2009	7/30/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Life	12/9/2009	7/30/2012
Active	All America Insurance Company	300078	Agent - Casualty	2/21/2019
Active	All America Insurance Company	300078	Agent - Property	2/21/2019
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	2/25/2002	11/21/2007
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	1/22/2002	11/21/2007
Inactive	American Casualty Company of Reading, Pennsylvania	300956	Agent - Casualty	12/15/2003	10/11/2005
Inactive	American Casualty Company of Reading, Pennsylvania	300956	Agent - Property	12/15/2003	10/11/2005
Inactive	American Commerce Insurance Company	301665	Agent - Casualty	4/6/2016	3/31/2018
Inactive	American Commerce Insurance Company	301665	Agent - Property	4/6/2016	3/31/2018
Active	American Economy Insurance Company	300315	Agent - Casualty	11/9/2019
Active	American Economy Insurance Company	300315	Agent - Property	11/9/2019
Active	American Fire and Casualty Company	300567	Agent - Casualty	9/9/2014
Active	American Fire and Casualty Company	300567	Agent - Property	9/9/2014
Inactive	American States Insurance Company	301230	Agent - Casualty	2/2/2011	10/1/2012
Inactive	American States Insurance Company	301230	Agent - Property	2/2/2011	10/1/2012
Active	Ansur America Insurance Company	520667	Agent - Casualty	3/12/2015
Active	Ansur America Insurance Company	520667	Agent - Property	3/12/2015
Inactive	Augustar Life Assurance Corporation	301113	Agent - Health	5/28/2002	3/10/2007
Inactive	Augustar Life Assurance Corporation	301113	Agent - Life	5/28/2002	3/10/2007
Inactive	Augustar Life Assurance Corporation	301113	Agent - Variable Life and Variable Annuities	5/28/2002	3/10/2007
Inactive	Augustar Life Insurance Company	301816	Agent - Health	5/28/2002	3/10/2007
Inactive	Augustar Life Insurance Company	301816	Agent - Life	5/28/2002	3/10/2007
Inactive	Augustar Life Insurance Company	301816	Agent - Variable Life and Variable Annuities	5/28/2002	3/10/2007
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Casualty	2/14/2014	5/31/2023
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Property	2/14/2014	5/31/2023
Active	Banner Life Insurance Company	301696	Agent - Life	1/10/2013
Inactive	Brighthouse Life Insurance Company	301829	Agent - Health	3/29/2001	4/15/2005
Inactive	Brighthouse Life Insurance Company	301829	Agent - Life	3/29/2001	10/9/2003
Active	Bristol West Insurance Company	301655	Agent - Casualty	8/31/2023
Active	Bristol West Insurance Company	301655	Agent - Property	8/31/2023
Active	Central Mutual Insurance Company	300965	Agent - Casualty	2/21/2019
Active	Central Mutual Insurance Company	300965	Agent - Property	2/21/2019
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	6/4/2013	12/9/2013
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	1/31/2005	4/1/2007
Active	ClearPath Insurance Company	979815	Agent - Casualty	2/29/2024
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/9/2013	12/8/2015
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	9/9/2014	4/26/2024
Inactive	Consolidated Insurance Company	300943	Agent - Property	9/9/2014	4/26/2024
Inactive	Continental Casualty Company	301019	Agent - Casualty	12/15/2003	10/11/2005
Inactive	Continental Casualty Company	301019	Agent - Property	12/15/2003	10/11/2005
Active	Country Mutual Insurance Company	301024	Agent - Casualty	1/1/2017
Active	Country Mutual Insurance Company	301024	Agent - Property	1/1/2017
Inactive	Delaware Life Insurance Company	301256	Agent - Life	2/15/2001	11/30/2006
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	8/9/2013	12/8/2015
Inactive	EMC National Life Company	300388	Agent - Health	5/11/2017	3/20/2024
Inactive	EMC National Life Company	300388	Agent - Life	5/11/2017	3/20/2024
Active	EMC Property & Casualty Company	955217	Agent - Casualty	5/18/2021
Active	EMC Property & Casualty Company	955217	Agent - Property	5/18/2021
Active	EMCASCO Insurance Company	842790	Agent - Casualty	2/12/2015
Active	EMCASCO Insurance Company	842790	Agent - Property	2/12/2015
Active	Employers Insurance Company of Wausau	301813	Agent - Casualty	11/25/2015
Active	Employers Insurance Company of Wausau	301813	Agent - Property	11/25/2015
Active	Employers Mutual Casualty Company	300202	Agent - Casualty	1/31/2014
Active	Employers Mutual Casualty Company	300202	Agent - Property	1/31/2014
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Health	12/3/2004	3/7/2011
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Life	12/3/2004	3/7/2011
Inactive	Encompass Indemnity Company	546376	Agent - Casualty	3/25/2020	5/13/2022
Inactive	Encompass Indemnity Company	546376	Agent - Property	3/25/2020	5/13/2022
Inactive	Encompass Insurance Company of America	556578	Agent - Casualty	2/15/2013	5/5/2018
Inactive	Encompass Insurance Company of America	556578	Agent - Property	2/15/2013	5/5/2018
Active	Erie Family Life Insurance Company	301400	Agent - Life	4/9/2019
Active	Erie Insurance Company	300230	Agent - Casualty	4/9/2019
Active	Erie Insurance Company	300230	Agent - Property	4/9/2019
Active	Erie Insurance Company of New York	789916	Agent - Casualty	4/9/2019
Active	Erie Insurance Company of New York	789916	Agent - Property	4/9/2019
Active	Erie Insurance Exchange	300789	Agent - Casualty	4/9/2019
Active	Erie Insurance Exchange	300789	Agent - Property	4/9/2019
Active	Erie Insurance Property & Casualty Company	789942	Agent - Casualty	4/9/2019
Active	Erie Insurance Property & Casualty Company	789942	Agent - Property	4/9/2019
Inactive	Everlake Life Insurance Company	300873	Agent - Life	1/1/2003	1/26/2005
Inactive	Farmers Insurance Exchange	300336	Agent - Casualty	11/20/2008	12/2/2011
Inactive	Farmers Insurance Exchange	300336	Agent - Property	11/20/2008	12/2/2011
Inactive	Farmington Casualty Company	301137	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Farmington Casualty Company	301137	Agent - Property	6/4/2013	12/9/2013
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	12/31/2007	10/1/2012
Active	First Benefits Insurance Mutual, Inc.	1090183	Agent - Casualty	2/13/2023
Active	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	11/25/2015
Active	First Liberty Insurance Corporation (The)	301060	Agent - Property	11/25/2015
Inactive	First National Insurance Company of America	301690	Agent - Casualty	10/7/2008	10/1/2012
Inactive	First National Insurance Company of America	301690	Agent - Property	10/7/2008	10/1/2012
Active	Flagship City Insurance Company	789965	Agent - Casualty	4/9/2019
Active	Flagship City Insurance Company	789965	Agent - Property	4/9/2019
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	1/30/2013
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	1/30/2013
Active	Frankenmuth Insurance Company	301481	Agent - Casualty	3/12/2015
Active	Frankenmuth Insurance Company	301481	Agent - Property	3/12/2015
Inactive	General Insurance Company of America	300261	Agent - Casualty	10/7/2008	10/1/2012
Inactive	General Insurance Company of America	300261	Agent - Property	10/7/2008	10/1/2012
Inactive	Genworth Life Insurance Company	300623	Agent - Health	8/28/2007	10/1/2012
Inactive	Genworth Life Insurance Company	300623	Agent - Life	8/28/2007	10/1/2012
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	10/16/2013	1/5/2015
Inactive	Golden Rule Insurance Company	301943	Agent - Health	10/26/2005	11/10/2008
Inactive	Golden Rule Insurance Company	301943	Agent - Life	10/26/2005	11/10/2008
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Casualty	1/31/2014	12/15/2017
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Property	1/31/2014	12/15/2017
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	3/4/2014	12/8/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	8/9/2013	8/11/2016
Inactive	Humana Insurance Company	301104	Agent - Health	8/9/2013	8/11/2016
Inactive	Humana Insurance Company	301104	Agent - Life	8/9/2013	8/11/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	8/9/2013	12/8/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	8/9/2013	12/8/2015
Inactive	HumanaDental Insurance Company	301457	Agent - Health	4/11/2012	10/1/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	4/11/2012	10/1/2012
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	7/12/2007	11/11/2010
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	7/12/2007	11/11/2010
Inactive	Indiana Insurance Company	301909	Agent - Casualty	9/9/2014	2/3/2023
Inactive	Indiana Insurance Company	301909	Agent - Property	9/9/2014	2/3/2023
Active	Insurance Company of the West	301520	Agent - Casualty	6/26/2020
Active	Insurance Company of the West	301520	Agent - Property	6/26/2020
Inactive	John Alden Life Insurance Company	300573	Agent - Health	10/15/2003	11/14/2006
Inactive	John Alden Life Insurance Company	300573	Agent - Life	10/15/2003	11/14/2006
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	2/19/2001	11/28/2005
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	2/19/2001	2/3/2005
Inactive	John Hancock Life Insurance Company	300821	Agent - Variable Life and Variable Annuities	5/31/2001	2/3/2005
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Health	2/19/2001	2/3/2005
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Life	2/19/2001	2/3/2005
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Variable Life and Variable Annuities	5/31/2001	2/3/2005
Inactive	Kanawha Insurance Company	300127	Agent - Health	5/13/2013	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	5/13/2013	10/22/2015
Inactive	Keyport Life Insurance Company	300319	Agent - Life	2/20/2001	12/31/2003
Active	LM Insurance Corporation	301061	Agent - Casualty	11/25/2015
Active	LM Insurance Corporation	301061	Agent - Property	11/25/2015
Active	Liberty Insurance Corporation	300444	Agent - Casualty	11/25/2015
Active	Liberty Insurance Corporation	300444	Agent - Property	11/25/2015
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	11/25/2015
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Property	11/25/2015
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	11/25/2015
Active	Liberty Mutual Insurance Company	301159	Agent - Property	11/25/2015
Inactive	Life Insurance Company of North America	300711	Agent - Health	12/18/2009	10/1/2012
Inactive	Life Insurance Company of North America	300711	Agent - Life	12/18/2009	10/1/2012
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	7/11/2001	10/11/2012
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	7/11/2001	10/11/2012
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Variable Life and Variable Annuities	7/11/2001	10/11/2012
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Life	7/24/2013	7/17/2017
Inactive	MetLife Life and Annuity Company of Connecticut	301593	Agent - Health	3/29/2001	4/15/2005
Inactive	MetLife Life and Annuity Company of Connecticut	301593	Agent - Life	3/29/2001	10/9/2003
Inactive	Middlesex Mutual Assurance Company	569442	Agent - Casualty	4/30/2015	12/31/2016
Inactive	Middlesex Mutual Assurance Company	569442	Agent - Property	4/30/2015	12/31/2016
Inactive	National Fire Insurance Company of Hartford	301063	Agent - Casualty	12/15/2003	10/11/2005
Inactive	National Fire Insurance Company of Hartford	301063	Agent - Property	12/15/2003	10/11/2005
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	7/11/2001	10/1/2012
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	7/11/2001	10/1/2012
Inactive	Nationwide Life Insurance Company	300495	Agent - Variable Life and Variable Annuities	7/11/2001	10/1/2012
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	7/11/2001	10/1/2012
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Variable Life and Variable Annuities	7/11/2001	10/1/2012
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	9/9/2014	4/26/2024
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	9/9/2014	4/26/2024
Inactive	Northbrook Life Insurance Company	301020	Agent - Life	5/10/2001	1/1/2003
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	9/9/2014
Active	Ohio Casualty Insurance Company	301492	Agent - Property	9/9/2014
Active	Ohio Security Insurance Company	300622	Agent - Casualty	9/9/2014
Active	Ohio Security Insurance Company	300622	Agent - Property	9/9/2014
Inactive	Pacific Life Insurance Company	301848	Agent - Life	7/13/2007	4/7/2010
Inactive	Pacific Life Insurance Company	301848	Agent - Variable Life and Variable Annuities	7/13/2007	4/7/2010
Active	Peerless Indemnity Insurance Company	571682	Agent - Casualty	9/9/2014
Active	Peerless Indemnity Insurance Company	571682	Agent - Property	9/9/2014
Active	Peerless Insurance Company	301910	Agent - Casualty	9/9/2014
Active	Peerless Insurance Company	301910	Agent - Property	9/9/2014
Active	Protective Life Insurance Company	300638	Agent - Health	12/27/2020
Active	Protective Life Insurance Company	300638	Agent - Life	12/27/2020
Inactive	Protective Life Insurance Company	300638	Agent - Variable Life and Variable Annuities	4/19/2004	11/23/2009
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	1/30/2002	9/16/2004
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	2/23/2018
Active	SAFECO Insurance Company of America	300159	Agent - Property	2/23/2018
Active	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	2/23/2018
Active	SAFECO Insurance Company of Illinois	301350	Agent - Property	2/23/2018
Inactive	Security Life of Denver Insurance Company	300648	Agent - Life	8/13/2001	11/13/2006
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	6/4/2013	12/9/2013
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	3/23/2021
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	3/23/2021
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	4/16/2004	9/21/2007
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	4/16/2004	9/21/2007
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Variable Life and Variable Annuities	4/16/2004	9/21/2007
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Health	4/16/2004	9/21/2007
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	4/16/2004	9/21/2007
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Variable Life and Variable Annuities	4/16/2004	9/21/2007
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	6/4/2013	12/9/2013
Inactive	The Phoenix Insurance Company	301502	Agent - Property	6/4/2013	12/9/2013
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	9/25/2013	1/29/2016
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	9/25/2013	1/29/2016
Inactive	Transcontinental Insurance Company	301731	Agent - Casualty	12/15/2003	10/11/2005
Inactive	Transcontinental Insurance Company	301731	Agent - Property	12/15/2003	10/11/2005
Inactive	Transportation Insurance Company	301575	Agent - Casualty	12/15/2003	10/11/2005
Inactive	Transportation Insurance Company	301575	Agent - Property	12/15/2003	10/11/2005
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	6/4/2013	12/9/2013
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	6/4/2013	12/9/2013
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	6/4/2013	12/9/2019
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	6/4/2013	12/9/2019
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	6/4/2013	12/9/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	6/4/2013	12/9/2013
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	6/4/2013	12/9/2013
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	6/4/2013	12/9/2013
Inactive	Truck Insurance Exchange	300335	Agent - Casualty	11/20/2008	12/2/2011
Inactive	Truck Insurance Exchange	300335	Agent - Property	11/20/2008	12/2/2011
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Life	12/16/2004	9/27/2007
Active	Union Insurance Company of Providence	842791	Agent - Casualty	2/12/2015
Active	Union Insurance Company of Providence	842791	Agent - Property	2/12/2015
Inactive	Valley Forge Insurance Company	301052	Agent - Casualty	12/15/2003	10/11/2005
Inactive	Valley Forge Insurance Company	301052	Agent - Property	12/15/2003	10/11/2005
Active	West American Insurance Company	301112	Agent - Casualty	9/9/2014
Active	West American Insurance Company	301112	Agent - Property	9/9/2014
Active	West Bend Insurance Company	672974	Agent - Casualty	8/18/2014
Active	West Bend Insurance Company	672974	Agent - Property	8/18/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bluegrass Insurance Services LLC	687604	Agent - Casualty	11/18/2014
Active	Bluegrass Insurance Services LLC	687604	Agent - Property	11/18/2014
Inactive	Dental Choice Agency Inc.	398085	Agent - Health	5/17/2013	8/11/2016
Active	Designated Agent Company Inc.	681257	Agent - Life	10/1/2014
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/13/2013	8/11/2016
Inactive	Duff Insurance Agency Inc.	400308	Agent - Life	4/12/2016	3/31/2018
Inactive	Duff Insurance Agency Inc.	400308	Agent - Health	4/12/2016	8/11/2016
Active	Duff Insurance Agency Inc.	400308	Agent - Casualty	6/6/2022
Active	Duff Insurance Agency Inc.	400308	Agent - Property	6/6/2022
Inactive	Duff of Louisville Inc.	399286	Agent - Casualty	2/13/2003	10/11/2005
Inactive	Duff of Louisville Inc.	399286	Agent - Property	2/13/2003	10/11/2005
Inactive	Medlink Inc	400721	Agent - Life	9/20/2017	3/31/2024
Inactive	Medlink Inc	400721	Agent - Health	9/20/2017	3/31/2024