DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	IC Insurance Services, LLC	DOIID	534848	NAIC NPN	4791665

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	7/27/2001	5/31/2005
Inactive	Non Resident	Agent	Casualty	7/27/2001	5/31/2005
Inactive	Non Resident	Agent	Health	7/27/2001	5/31/2005
Inactive	Non Resident	Agent	Property	7/27/2001	5/31/2005
* 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	Fidelity Investments Life Insurance Company	300620	Agent - Health	7/27/2001	5/31/2005
Inactive	Fidelity Investments Life Insurance Company	300620	Agent - Life	7/27/2001	5/31/2005
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	4/23/2002	5/31/2005
Inactive	Lincoln Life Assurance Company of Boston	301915	Agent - Health	1/30/2004	5/31/2005
Inactive	Lincoln Life Assurance Company of Boston	301915	Agent - Life	1/30/2004	5/31/2005
Inactive	RiverStone International Insurance, Inc.	301758	Agent - Casualty	7/27/2001	10/17/2003
Inactive	RiverStone International Insurance, Inc.	301758	Agent - Property	7/27/2001	10/17/2003

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Belden, Samuel	526519	Agent - Casualty	1/5/2004	5/31/2005
Inactive	Belden, Samuel	526519	Agent - Health	1/5/2004	5/31/2005
Inactive	Belden, Samuel	526519	Agent - Life	1/5/2004	5/31/2005
Inactive	Belden, Samuel	526519	Agent - Property	1/5/2004	5/31/2005
Inactive	Paul, Steven William	534692	Agent - Casualty	7/27/2001	10/17/2003
Inactive	Paul, Steven William	534692	Agent - Health	7/27/2001	10/18/2004
Inactive	Paul, Steven William	534692	Agent - Life	7/27/2001	10/18/2004
Inactive	Paul, Steven William	534692	Agent - Property	7/27/2001	10/17/2003
Inactive	Walsh, Kristi Marie	534689	Agent - Casualty	7/27/2001	10/17/2003
Inactive	Walsh, Kristi Marie	534689	Agent - Health	7/27/2001	9/14/2004
Inactive	Walsh, Kristi Marie	534689	Agent - Life	7/27/2001	9/14/2004
Inactive	Walsh, Kristi Marie	534689	Agent - Property	7/27/2001	10/17/2003