DEPARTMENT OF INSURANCE

Affiliations

Name	Hennessey, Chad Alan	DOIID	518424	NAIC NPN	7215705

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Health	6/30/2006	8/31/2026
Active	Resident	Agent	Life	5/13/2003	8/31/2026
Active	Resident	Agent	Casualty	6/20/2001	8/31/2026
Active	Resident	Agent	Property	2/12/2001	8/31/2026
Active	Resident	Surplus Lines Broker	Not Applicable	5/13/2019	8/31/2026
* 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
Agent	06/15/2026	08/31/2026
Surplus Lines Broker	06/15/2026	08/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	1842 Insurance Company	1357117	Agent - Casualty	6/11/2025
Active	1842 Insurance Company	1357117	Agent - Property	6/11/2025
Inactive	1st Choice Advantage Insurance Company, Inc.	750782	Agent - Casualty	9/22/2011	10/1/2021
Active	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	12/15/2022
Active	ACUITY, A Mutual Insurance Company	300095	Agent - Property	12/15/2022
Inactive	Addison Insurance Company	874810	Agent - Casualty	4/28/2017	9/7/2021
Inactive	Addison Insurance Company	874810	Agent - Property	4/28/2017	9/7/2021
Active	Allied Eastern Indemnity Company	683842	Agent - Casualty	10/31/2022
Active	American Economy Insurance Company	300315	Agent - Casualty	6/1/2022
Active	American Economy Insurance Company	300315	Agent - Property	6/1/2022
Active	American Fire and Casualty Company	300567	Agent - Casualty	4/27/2004
Active	American Fire and Casualty Company	300567	Agent - Property	4/27/2004
Inactive	American General Life Insurance Company	301585	Agent - Health	6/26/2014	8/9/2024
Inactive	American General Life Insurance Company	301585	Agent - Life	6/26/2014	8/9/2024
Active	American National Insurance Company	301861	Agent - Life	7/10/2019
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	9/7/2012	11/30/2016
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	9/7/2012	11/30/2016
Inactive	Association Casualty Insurance Company	650779	Agent - Casualty	9/19/2017	7/12/2018
Inactive	Association Casualty Insurance Company	650779	Agent - Property	9/19/2017	7/12/2018
Inactive	Assurance Company of America	300432	Agent - Casualty	6/20/2001	12/16/2014
Inactive	Assurance Company of America	300432	Agent - Property	3/15/2001	12/16/2014
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Casualty	3/3/2009	9/21/2016
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Property	3/3/2009	9/21/2016
Active	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	6/20/2001
Active	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	5/3/2001
Inactive	Banner Life Insurance Company	301696	Agent - Life	7/12/2005	5/27/2024
Active	Bridgefield Casualty Insurance Company	500013	Agent - Casualty	8/15/2012
Active	Brighthouse Life Insurance Company	301829	Agent - Health	11/14/2014
Active	Brighthouse Life Insurance Company	301829	Agent - Life	11/14/2014
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	11/24/2008	12/20/2024
Inactive	Bristol West Insurance Company	301655	Agent - Property	11/24/2008	12/20/2024
Active	BusinessFirst Insurance Company	722488	Agent - Casualty	5/2/2024
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	6/20/2001	12/3/2014
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	5/3/2001	12/3/2014
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	3/25/2004	4/1/2007
Active	Cincinnati Casualty Company (The)	300308	Agent - Casualty	1/6/2023
Active	Cincinnati Casualty Company (The)	300308	Agent - Property	1/6/2023
Active	Cincinnati Indemnity Company (The)	301566	Agent - Casualty	1/6/2023
Active	Cincinnati Indemnity Company (The)	301566	Agent - Property	1/6/2023
Active	Cincinnati Insurance Company	301298	Agent - Casualty	1/6/2023
Active	Cincinnati Insurance Company	301298	Agent - Property	1/6/2023
Active	Cincinnati Life Insurance Company (The)	300601	Agent - Life	2/21/2020
Active	ClearPath Insurance Company	979815	Agent - Casualty	2/29/2024
Inactive	Columbia Mutual Insurance Company	301295	Agent - Casualty	9/19/2017	7/12/2018
Inactive	Columbia Mutual Insurance Company	301295	Agent - Property	9/19/2017	7/12/2018
Inactive	Columbia National Insurance Company	751543	Agent - Casualty	1/15/2018	7/12/2018
Inactive	Columbia National Insurance Company	751543	Agent - Property	1/15/2018	7/12/2018
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	6/20/2001	7/30/2009
Inactive	Consolidated Insurance Company	300943	Agent - Property	3/26/2001	7/30/2009
Inactive	Country Mutual Insurance Company	301024	Agent - Casualty	1/1/2017	6/13/2019
Inactive	Country Mutual Insurance Company	301024	Agent - Property	1/1/2017	6/13/2019
Inactive	EMC National Life Company	300388	Agent - Health	2/6/2014	5/10/2018
Inactive	EMC National Life Company	300388	Agent - Life	2/6/2014	5/10/2018
Inactive	EMCASCO Insurance Company	842790	Agent - Casualty	2/12/2015	2/15/2018
Inactive	EMCASCO Insurance Company	842790	Agent - Property	2/12/2015	2/15/2018
Active	Eastern Advantage Assurance Company	692390	Agent - Casualty	10/31/2022
Active	Eastern Alliance Insurance Company	683841	Agent - Casualty	10/31/2022
Inactive	Employers Mutual Casualty Company	300202	Agent - Casualty	2/6/2014	2/15/2018
Inactive	Employers Mutual Casualty Company	300202	Agent - Property	2/6/2014	2/15/2018
Inactive	Encompass Indemnity Company	546376	Agent - Casualty	11/9/2012	10/3/2024
Inactive	Encompass Indemnity Company	546376	Agent - Property	11/9/2012	10/3/2024
Active	Encompass Insurance Company	300188	Agent - Casualty	2/1/2025
Active	Encompass Insurance Company	300188	Agent - Property	2/1/2025
Inactive	Encompass Insurance Company of America	556578	Agent - Casualty	11/9/2012	10/3/2024
Inactive	Encompass Insurance Company of America	556578	Agent - Property	11/9/2012	10/3/2024
Inactive	Encova Life Insurance Company	301818	Agent - Life	12/22/2003	1/14/2015
Inactive	Equitable Financial Life Insurance Company	300808	Agent - Health	1/23/2012	12/28/2018
Inactive	Equitable Financial Life Insurance Company	300808	Agent - Life	1/23/2012	12/28/2018
Inactive	Everett Cash Mutual Insurance Company	750768	Agent - Casualty	9/22/2011	10/1/2021
Inactive	Everett Cash Mutual Insurance Company	750768	Agent - Property	9/22/2011	10/1/2021
Inactive	Farmers Insurance Exchange	300336	Agent - Casualty	9/16/2003	8/21/2012
Inactive	Farmers Insurance Exchange	300336	Agent - Property	9/16/2003	8/21/2012
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	2/2/2017	2/24/2024
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	2/2/2017	2/24/2024
Inactive	First Colony Life Insurance Company	301179	Agent - Life	6/22/2004	1/1/2007
Inactive	First National Insurance Company of America	301690	Agent - Casualty	10/7/2008	10/15/2021
Inactive	First National Insurance Company of America	301690	Agent - Property	10/7/2008	10/15/2021
Active	Firstline Insurance Company	1322897	Agent - Casualty	6/11/2025
Active	Firstline Insurance Company	1322897	Agent - Property	6/11/2025
Active	GEICO Marine Insurance Company	590512	Agent - Casualty	4/22/2025
Active	GEICO Marine Insurance Company	590512	Agent - Property	4/22/2025
Inactive	General Insurance Company of America	300261	Agent - Casualty	10/7/2008	10/15/2021
Inactive	General Insurance Company of America	300261	Agent - Property	10/7/2008	10/15/2021
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Health	4/25/2009	12/7/2012
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	3/13/2014	12/14/2016
Inactive	Glatfelter Insurance Company	301640	Agent - Casualty	6/20/2001	11/30/2007
Inactive	Glatfelter Insurance Company	301640	Agent - Property	3/15/2001	11/30/2007
Inactive	GuideOne Elite Insurance Company	300490	Agent - Casualty	3/1/2013	11/3/2021
Inactive	GuideOne Elite Insurance Company	300490	Agent - Property	3/1/2013	11/3/2021
Inactive	GuideOne Insurance Company	301794	Agent - Casualty	3/1/2013	11/3/2021
Inactive	GuideOne Insurance Company	301794	Agent - Property	3/1/2013	11/3/2021
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Casualty	3/8/2016	11/3/2021
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Property	3/8/2016	11/3/2021
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Casualty	2/6/2014	12/15/2017
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Property	2/6/2014	12/15/2017
Active	Harford Mutual Insurance Company	200223	Agent - Casualty	6/11/2025
Active	Harford Mutual Insurance Company	200223	Agent - Property	6/11/2025
Active	Hartford Accident and Indemnity Company	301917	Agent - Casualty	6/15/2020
Active	Hartford Accident and Indemnity Company	301917	Agent - Property	6/15/2020
Inactive	Hartford Casualty Insurance Company	301332	Agent - Casualty	2/6/2015	8/18/2017
Inactive	Hartford Casualty Insurance Company	301332	Agent - Property	2/6/2015	8/18/2017
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	12/15/2005	11/16/2009
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	12/15/2005	11/16/2009
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	12/15/2005	11/16/2009
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	12/15/2005	11/16/2009
Active	Hartford Underwriters Insurance Company	301064	Agent - Casualty	4/29/2021
Active	Hartford Underwriters Insurance Company	301064	Agent - Property	4/29/2021
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/26/2008	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Health	3/26/2008	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Life	3/26/2008	9/8/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	3/26/2008	9/8/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	3/26/2008	9/8/2010
Inactive	Indiana Insurance Company	301909	Agent - Casualty	6/20/2001	7/30/2009
Inactive	Indiana Insurance Company	301909	Agent - Property	3/26/2001	7/30/2009
Inactive	Infinity Standard Insurance Company	301643	Agent - Casualty	6/20/2001	10/18/2004
Inactive	Infinity Standard Insurance Company	301643	Agent - Property	4/16/2001	10/18/2004
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	10/9/2019	6/23/2022
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	10/9/2019	6/23/2022
Active	Keystone National Insurance Company	745173	Agent - Casualty	4/17/2020
Active	Keystone National Insurance Company	745173	Agent - Property	4/17/2020
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	9/7/2017	10/30/2023
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	9/7/2017	10/30/2023
Active	MICO Insurance Company	301664	Agent - Casualty	9/26/2023
Active	MICO Insurance Company	301664	Agent - Property	9/26/2023
Inactive	Maryland Casualty Company	301719	Agent - Property	3/15/2001	12/16/2014
Active	Massachusetts Mutual Life Insurance Company	300445	Agent - Life	11/22/2021
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Health	11/17/2008	11/14/2014
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	11/17/2008	11/14/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	11/22/2013	4/27/2018
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	11/22/2013	4/27/2018
Inactive	Middlesex Mutual Assurance Company	569442	Agent - Casualty	8/1/2008	12/31/2016
Inactive	Middlesex Mutual Assurance Company	569442	Agent - Property	8/1/2008	12/31/2016
Active	Milbank Insurance Company	925185	Agent - Casualty	2/13/2020
Active	Milbank Insurance Company	925185	Agent - Property	2/13/2020
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Casualty	4/10/2019
Active	Motorists Mutual Insurance Company	300963	Agent - Casualty	2/25/2019
Active	Motorists Mutual Insurance Company	300963	Agent - Property	2/25/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	6/20/2001	7/30/2009
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	3/26/2001	7/30/2009
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	5/29/2016	4/23/2019
Inactive	Northern Insurance Company of New York	301317	Agent - Casualty	6/20/2001	12/16/2014
Inactive	Northern Insurance Company of New York	301317	Agent - Property	3/16/2001	12/16/2014
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	8/8/2002
Active	Ohio Casualty Insurance Company	301492	Agent - Property	8/8/2002
Active	Ohio Security Insurance Company	300622	Agent - Casualty	4/27/2004
Active	Ohio Security Insurance Company	300622	Agent - Property	4/27/2004
Inactive	Old Guard Insurance Company	533854	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Old Guard Insurance Company	533854	Agent - Property	6/2/2021	6/11/2021
Inactive	PHL Variable Insurance Company	300525	Agent - Life	8/22/2011	11/11/2016
Active	Pacific Life Insurance Company	301848	Agent - Health	5/31/2024
Active	Pacific Life Insurance Company	301848	Agent - Life	5/31/2024
Active	Peerless Indemnity Insurance Company	571682	Agent - Casualty	9/8/2007
Active	Peerless Indemnity Insurance Company	571682	Agent - Property	9/8/2007
Inactive	Peerless Insurance Company	301910	Agent - Casualty	6/20/2001	7/30/2009
Inactive	Peerless Insurance Company	301910	Agent - Property	3/26/2001	7/30/2009
Active	Phenix Mutual Fire Insurance Company	1295814	Agent - Casualty	12/18/2025
Active	Phenix Mutual Fire Insurance Company	1295814	Agent - Property	12/18/2025
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Casualty	3/29/2010
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Property	3/29/2010
Active	Plaza Insurance Company	300748	Agent - Casualty	4/28/2022
Active	Plaza Insurance Company	300748	Agent - Property	4/28/2022
Active	Principal Life Insurance Company	300129	Agent - Health	6/25/2009
Active	Principal Life Insurance Company	300129	Agent - Life	6/25/2009
Active	Principal National Life Insurance Company	301926	Agent - Life	1/25/2012
Active	Privilege Underwriters Reciprocal Exchange	769657	Agent - Casualty	10/12/2023
Active	Privilege Underwriters Reciprocal Exchange	769657	Agent - Property	10/12/2023
Active	Property and Casualty Insurance Company of Hartford	301409	Agent - Casualty	7/3/2022
Active	Property and Casualty Insurance Company of Hartford	301409	Agent - Property	7/3/2022
Inactive	Protective Insurance Company	301117	Agent - Casualty	12/6/2017	4/6/2018
Inactive	Protective Insurance Company	301117	Agent - Property	12/6/2017	4/6/2018
Active	Protective Life Insurance Company	300638	Agent - Life	2/2/2026
Inactive	Pruco Life Insurance Company	300954	Agent - Health	9/12/2006	12/21/2022
Active	Pruco Life Insurance Company	300954	Agent - Life	4/25/2023
Denied	Reassure America Life Insurance Company	301902	Agent - Health
Denied	Reassure America Life Insurance Company	301902	Agent - Life
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	11/7/2006	2/27/2016
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	10/7/2008
Active	SAFECO Insurance Company of America	300159	Agent - Property	10/7/2008
Active	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	6/7/2022
Active	SAFECO Insurance Company of Illinois	301350	Agent - Property	6/7/2022
Inactive	Sagamore Insurance Company	300942	Agent - Casualty	11/3/2016	4/6/2018
Inactive	Sagamore Insurance Company	300942	Agent - Property	11/3/2016	4/6/2018
Active	Selective Insurance Company of America	500018	Agent - Casualty	9/29/2014
Active	Selective Insurance Company of America	500018	Agent - Property	9/29/2014
Active	Selective Insurance Company of South Carolina	500012	Agent - Casualty	9/29/2014
Active	Selective Insurance Company of South Carolina	500012	Agent - Property	9/29/2014
Active	Selective Insurance Company of the Southeast	300381	Agent - Casualty	9/29/2014
Active	Selective Insurance Company of the Southeast	300381	Agent - Property	9/29/2014
Active	Sentinel Insurance Company, Limited	501696	Agent - Casualty	12/13/2022
Active	Sentinel Insurance Company, Limited	501696	Agent - Property	12/13/2022
Active	Standard Fire Insurance Company (The)	301068	Agent - Casualty	6/20/2001
Active	Standard Fire Insurance Company (The)	301068	Agent - Property	5/3/2001
Inactive	Standard Insurance Company	300185	Agent - Health	2/1/2008	12/5/2022
Inactive	Standard Insurance Company	300185	Agent - Life	2/1/2008	12/5/2022
Active	State Auto Property & Casualty Insurance Company	301953	Agent - Casualty	2/13/2020
Active	State Auto Property & Casualty Insurance Company	301953	Agent - Property	2/13/2020
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	4/21/2023
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	4/21/2023
Inactive	Symetra Life Insurance Company	301691	Agent - Health	2/28/2022	12/29/2024
Inactive	Symetra Life Insurance Company	301691	Agent - Life	2/28/2022	12/29/2024
Active	The Phoenix Insurance Company	301502	Agent - Casualty	6/20/2001
Active	The Phoenix Insurance Company	301502	Agent - Property	5/3/2001
Inactive	The Savings Bank Mutual Life Insurance Company of Massachusetts	690290	Agent - Life	8/30/2013	11/29/2018
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	6/1/2021	9/16/2025
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	6/1/2021	9/16/2025
Inactive	Transamerica Occidental Life Insurance Company	300966	Agent - Health	4/16/2008	10/1/2008
Inactive	Transamerica Occidental Life Insurance Company	300966	Agent - Life	4/16/2008	10/1/2008
Inactive	TravCo Insurance Company	301828	Agent - Casualty	6/20/2001	12/5/2013
Inactive	TravCo Insurance Company	301828	Agent - Property	5/3/2001	12/5/2013
Inactive	Travelers Casualty Company of Connecticut	301505	Agent - Casualty	9/3/2002	12/5/2013
Inactive	Travelers Casualty Company of Connecticut	301505	Agent - Property	9/3/2002	12/5/2013
Active	Travelers Home and Marine Insurance Company (The)	301802	Agent - Casualty	7/18/2005
Active	Travelers Home and Marine Insurance Company (The)	301802	Agent - Property	7/18/2005
Active	Travelers Indemnity Company (The)	301855	Agent - Casualty	6/20/2001
Active	Travelers Indemnity Company (The)	301855	Agent - Property	5/3/2001
Inactive	Travelers Property Casualty Insurance Company	301508	Agent - Casualty	9/3/2002	12/5/2013
Inactive	Travelers Property Casualty Insurance Company	301508	Agent - Property	9/3/2002	12/5/2013
Inactive	Truck Insurance Exchange	300335	Agent - Casualty	6/1/2007	8/21/2012
Inactive	Truck Insurance Exchange	300335	Agent - Property	6/1/2007	8/21/2012
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	12/15/2005	11/16/2009
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	12/15/2005	11/16/2009
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Life	10/10/2005	10/19/2007
Inactive	Union Insurance Company of Providence	842791	Agent - Casualty	2/12/2015	2/15/2018
Inactive	Union Insurance Company of Providence	842791	Agent - Property	2/12/2015	2/15/2018
Inactive	United Fire & Casualty Company	301374	Agent - Casualty	4/28/2017	9/7/2021
Inactive	United Fire & Casualty Company	301374	Agent - Property	4/28/2017	9/7/2021
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	1/15/2016	11/22/2016
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	1/15/2016	11/22/2016
Inactive	Unitrin Auto and Home Insurance Company	301538	Agent - Casualty	4/8/2005	10/23/2024
Inactive	Unitrin Auto and Home Insurance Company	301538	Agent - Property	4/8/2005	10/23/2024
Inactive	Unitrin Preferred Insurance Company	502869	Agent - Casualty	4/8/2005	12/2/2013
Inactive	Unitrin Preferred Insurance Company	502869	Agent - Property	4/8/2005	12/2/2013
Inactive	Unitrin Safeguard Insurance Company	301371	Agent - Casualty	10/11/2018	10/23/2024
Inactive	Unitrin Safeguard Insurance Company	301371	Agent - Property	10/11/2018	10/23/2024
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Health	8/22/2007	6/6/2008
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	8/22/2007	6/6/2008
Active	West American Insurance Company	301112	Agent - Casualty	4/27/2004
Active	West American Insurance Company	301112	Agent - Property	4/27/2004
Inactive	West Bend Insurance Company	672974	Agent - Casualty	10/25/2011	12/27/2017
Inactive	West Bend Insurance Company	672974	Agent - Property	10/25/2011	12/27/2017
Inactive	West Coast Life Insurance Company	301607	Agent - Life	1/22/2004	11/16/2011
Inactive	Western National Life Insurance Company	300461	Agent - Life	7/15/2004	11/21/2007
Inactive	Westfield Champion Insurance Company	1054839	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Champion Insurance Company	1054839	Agent - Property	6/2/2021	6/11/2021
Active	Westfield Insurance Company	301950	Agent - Casualty	10/19/2020
Active	Westfield Insurance Company	301950	Agent - Property	10/19/2020
Inactive	Westfield Premier Insurance Company	1055055	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Premier Insurance Company	1055055	Agent - Property	6/2/2021	6/11/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Property	6/2/2021	6/11/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Property	6/2/2021	6/11/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Insuramax LLC	400061	Agent - Property	10/10/2001
Active	Insuramax LLC	400061	Agent - Casualty	10/10/2001
Active	Insuramax LLC	400061	Agent - Life	8/11/2003
Active	Insuramax LLC	400061	Agent - Health	9/18/2008
Active	Insuramax LLC	400061	Surplus Lines Broker - Not Applicable	5/16/2019
Inactive	Keystone Insurance & Benefits Group, LLC	716920	Agent - Life	10/14/2015	6/18/2025
Inactive	Keystone Insurance & Benefits Group, LLC	716920	Agent - Health	10/14/2015	6/18/2025