DEPARTMENT OF INSURANCE

Affiliations

Name	Petty, Pamela S	DOIID	522633	NAIC NPN	7216694

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Property	11/18/2008	7/1/2019
Inactive	Resident	Agent	Casualty	11/18/2008	7/1/2019
Inactive	Resident	Agent	Health	2/12/2008	7/1/2019
Inactive	Resident	Agent	Life	2/12/2008	7/1/2019
* 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	American General Life and Accident Insurance Company	301362	Agent - Health	4/5/2002	9/17/2002
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	4/12/2002	9/17/2002
Inactive	American Retirement Life Insurance Company	706303	Agent - Health	4/29/2015	12/21/2018
Inactive	American Retirement Life Insurance Company	706303	Agent - Life	4/29/2015	12/21/2018
Inactive	Auto-Owners Insurance Company	301480	Agent - Casualty	1/19/2009	7/1/2019
Inactive	Auto-Owners Insurance Company	301480	Agent - Property	1/19/2009	7/1/2019
Inactive	Auto-Owners Life Insurance Company	301368	Agent - Health	6/22/2009	7/1/2019
Inactive	Auto-Owners Life Insurance Company	301368	Agent - Life	6/22/2009	7/1/2019
Inactive	Banner Life Insurance Company	301696	Agent - Life	9/29/2017	7/1/2019
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Health	6/24/2010	6/4/2018
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Life	6/24/2010	6/4/2018
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	12/16/2016	12/21/2018
Inactive	Cincinnati Life Insurance Company (The)	300601	Agent - Health	10/19/2010	7/1/2019
Inactive	Cincinnati Life Insurance Company (The)	300601	Agent - Life	10/19/2010	7/1/2019
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	12/14/2015	12/13/2016
Inactive	CompBenefits Insurance Company	301864	Agent - Health	8/13/2010	7/2/2013
Inactive	CompBenefits Insurance Company	301864	Agent - Life	8/13/2010	7/2/2013
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	10/28/2010	12/28/2012
Inactive	Dairyland Insurance Company	301370	Agent - Property	10/28/2010	12/28/2012
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/9/2009	4/10/2017
Inactive	EMC National Life Company	300388	Agent - Health	10/29/2009	10/3/2016
Inactive	EMC National Life Company	300388	Agent - Life	10/29/2009	10/3/2016
Inactive	EMCASCO Insurance Company	842790	Agent - Casualty	2/13/2015	7/1/2019
Inactive	EMCASCO Insurance Company	842790	Agent - Property	2/13/2015	7/1/2019
Inactive	Employers Mutual Casualty Company	300202	Agent - Casualty	10/29/2009	7/1/2019
Inactive	Employers Mutual Casualty Company	300202	Agent - Property	10/29/2009	7/1/2019
Inactive	Everett Cash Mutual Insurance Company	750768	Agent - Casualty	2/1/2018	7/1/2019
Inactive	Everett Cash Mutual Insurance Company	750768	Agent - Property	2/1/2018	7/1/2019
Inactive	Genworth Life Insurance Company	300623	Agent - Health	10/12/2010	12/7/2012
Inactive	Genworth Life Insurance Company	300623	Agent - Life	10/12/2010	12/7/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Health	6/28/2010	12/17/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	6/28/2010	12/17/2012
Inactive	Government Personnel Mutual Life Insurance Company	301862	Agent - Health	7/15/2010	3/24/2014
Inactive	Government Personnel Mutual Life Insurance Company	301862	Agent - Life	7/15/2010	3/24/2014
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Casualty	10/29/2009	12/20/2017
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Property	10/29/2009	12/20/2017
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/9/2009	4/10/2017
Inactive	Humana Insurance Company	301104	Agent - Health	8/13/2010	4/10/2017
Inactive	Humana Insurance Company	301104	Agent - Life	8/13/2010	4/10/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/9/2009	12/5/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/9/2009	12/5/2014
Inactive	HumanaDental Insurance Company	301457	Agent - Health	4/2/2012	12/19/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	4/2/2012	12/19/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	12/12/2014	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	12/12/2014	10/22/2015
Inactive	Kentucky Health Cooperative, Inc.	798780	Agent - Health	11/11/2013	10/29/2015
Inactive	Modern Woodmen of America	301213	Agent - Life	4/16/2003	8/13/2003
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	6/29/2010	12/17/2012
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Health	4/22/2002	2/10/2003
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	4/22/2002	2/10/2003
Inactive	Owners Insurance Company	300796	Agent - Casualty	1/19/2009	7/1/2019
Inactive	Owners Insurance Company	300796	Agent - Property	1/19/2009	7/1/2019
Inactive	Time Insurance Company	300683	Agent - Health	6/2/2014	7/1/2019
Inactive	Time Insurance Company	300683	Agent - Life	6/2/2014	7/1/2019
Inactive	Union Insurance Company of Providence	842791	Agent - Casualty	2/13/2015	7/1/2019
Inactive	Union Insurance Company of Providence	842791	Agent - Property	2/13/2015	7/1/2019
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	9/3/2015	7/22/2016
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	9/3/2015	7/22/2016
Inactive	Western National Life Insurance Company	300461	Agent - Life	4/25/2002	4/14/2003
Inactive	Woodmen of the World Life Insurance Society	301446	Agent - Health	8/2/2002	8/31/2003
Inactive	Woodmen of the World Life Insurance Society	301446	Agent - Life	8/2/2002	5/23/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	B.R.& W. Insurance Corp	399500	Agent - Life	6/23/2010	7/1/2019
Inactive	B.R.& W. Insurance Corp	399500	Agent - Health	6/23/2010	7/1/2019
Inactive	Chas. M. Moore Insurance Agency Inc.	400317	Agent - Life	3/2/2016	7/1/2019
Inactive	Chas. M. Moore Insurance Agency Inc.	400317	Agent - Health	3/2/2016	7/1/2019
Inactive	Chas. M. Moore Insurance Agency Inc.	400317	Agent - Casualty	3/2/2016	7/1/2019
Inactive	Chas. M. Moore Insurance Agency Inc.	400317	Agent - Property	3/2/2016	7/1/2019
Inactive	Clarke Management Group LLC	399650	Agent - Life	7/1/2009	3/31/2016
Inactive	Clarke Management Group LLC	399650	Agent - Health	7/1/2009	3/31/2016
Inactive	Clarke Management Group LLC	399650	Agent - Casualty	1/19/2009	3/31/2016
Inactive	Clarke Management Group LLC	399650	Agent - Property	1/19/2009	3/31/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/11/2013	7/1/2019
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/11/2013	7/1/2019
Inactive	Keystone Ins & Benefits Group LLC	716920	Agent - Life	10/12/2011	7/1/2019
Inactive	Keystone Ins & Benefits Group LLC	716920	Agent - Health	10/12/2011	7/1/2019
Denied	Medlink Inc	400721	Agent - Life
Denied	Medlink Inc	400721	Agent - Health
Inactive	Planchoice Inc.	400482	Agent - Health	4/17/2014	7/1/2019
Inactive	Wealth Preservation & Management Inc	562345	Agent - Life	10/15/2010	7/1/2019
Inactive	Wealth Preservation & Management Inc	562345	Agent - Health	10/15/2010	7/1/2019