DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Rose Marie	DOIID	521494	NAIC NPN	310413

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	2/9/2001	10/31/2008
Inactive	Non Resident	Agent	Health	2/9/2001	10/31/2008
Inactive	Non Resident	Agent	Casualty	2/9/2001	10/31/2008
* 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	Fairmont Insurance Company	301924	Agent - Casualty	3/19/2001	7/7/2003
Inactive	Fairmont Insurance Company	301924	Agent - Property	3/19/2001	7/7/2003
Inactive	Granite State Insurance Company	300818	Agent - Casualty	2/18/2003	10/31/2008
Inactive	Granite State Insurance Company	300818	Agent - Property	2/18/2003	10/31/2008
Inactive	Great American Assurance Company	300327	Agent - Casualty	7/8/2002	6/13/2008
Inactive	Great American Assurance Company	300327	Agent - Property	7/8/2002	6/13/2008
Inactive	Illinois National Insurance Company	301367	Agent - Casualty	2/18/2003	10/31/2008
Inactive	Illinois National Insurance Company	301367	Agent - Property	2/18/2003	10/31/2008
Inactive	New Hampshire Insurance Company	301670	Agent - Casualty	2/18/2003	10/31/2008
Inactive	New Hampshire Insurance Company	301670	Agent - Property	2/18/2003	10/31/2008
Inactive	StarStone National Insurance Company	300812	Agent - Casualty	3/19/2001	7/7/2003
Inactive	StarStone National Insurance Company	300812	Agent - Property	3/19/2001	7/7/2003
Inactive	TIG Insurance Company	301750	Agent - Casualty	2/9/2001	7/7/2003
Inactive	TIG Insurance Company	301750	Agent - Health	2/9/2001	7/7/2003
Inactive	TIG Insurance Company	301750	Agent - Property	2/9/2001	7/7/2003
Inactive	Virginia Surety Company, Inc.	301022	Agent - Casualty	2/25/2002	8/24/2006
Inactive	Virginia Surety Company, Inc.	301022	Agent - Health	2/18/2003	10/31/2008
Inactive	Virginia Surety Company, Inc.	301022	Agent - Property	2/25/2002	8/24/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	K & K Insurance Group Inc	513466	Agent - Property	9/23/2002	10/31/2008
Inactive	K & K Insurance Group Inc	513466	Agent - Casualty	9/23/2002	10/31/2008
Inactive	K & K Insurance Group Inc	513466	Agent - Health	10/22/2002	10/31/2008