DEPARTMENT OF INSURANCE

Affiliations

Name	Mantz, Douglas R	DOIID	535402	NAIC NPN	964788

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Administrator	Not Applicable	12/10/2018	10/31/2024
Inactive	Non Resident	Agent	Property	6/17/2019	10/31/2024
Inactive	Non Resident	Agent	Life	8/17/2001	10/31/2024
Inactive	Non Resident	Agent	Health	8/17/2001	10/31/2024
Inactive	Non Resident	Agent	Casualty	6/17/2019	10/31/2024
* 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 Heritage Life Insurance Company	300272	Agent - Health	5/20/2022	10/31/2024
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	5/20/2022	10/31/2024
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Health	9/24/2001	10/31/2024
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Life	2/24/2009	10/31/2024
Inactive	HM Life Insurance Company	301408	Agent - Health	11/9/2005	12/29/2016
Inactive	HM Life Insurance Company	301408	Agent - Life	11/9/2005	12/29/2016
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/21/2014	5/4/2017
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/21/2014	5/4/2017
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	1/9/2019	11/30/2023
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	1/9/2019	11/30/2023
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	8/17/2001	8/5/2016
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	8/17/2001	8/5/2016
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	8/17/2001	6/25/2008
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	8/17/2001	6/25/2008
Inactive	Security Mutual Life Insurance Company of NY	300708	Agent - Health	1/16/2020	10/31/2024
Inactive	Security Mutual Life Insurance Company of NY	300708	Agent - Life	1/16/2020	10/31/2024
Inactive	Starmount Life Insurance Company	628031	Agent - Health	1/9/2019	11/30/2023
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	1/9/2019	11/30/2023
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	1/9/2019	11/30/2023
Inactive	Unum Insurance Company	301499	Agent - Health	1/9/2019	11/30/2023
Inactive	Unum Insurance Company	301499	Agent - Life	1/9/2019	11/30/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aon Consulting Inc NJ	399932	Agent - Health	6/1/2020	10/31/2024
Inactive	Aon Consulting Inc NJ	399932	Agent - Life	6/1/2020	10/31/2024
Denied	Aon Consulting Inc NJ	399932	Agent - Casualty
Denied	Aon Consulting Inc NJ	399932	Agent - Property
Inactive	Farmington Administrative Services LLC	564133	Administrator - Not Applicable	1/24/2019	10/31/2024
Inactive	The Farmington Company	534046	Agent - Health	1/5/2004	3/31/2021
Inactive	The Farmington Company	534046	Agent - Life	1/5/2004	3/31/2021
Inactive	The Farmington Company	534046	Agent - Casualty	10/20/2019	3/31/2021
Inactive	The Farmington Company	534046	Agent - Property	10/20/2019	3/31/2021