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	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	12/10/2018	10/31/2024
Active	Non Resident	Agent	Casualty	6/17/2019	10/31/2024
Active	Non Resident	Agent	Life	8/17/2001	10/31/2024
Active	Non Resident	Agent	Property	6/17/2019	10/31/2024
Active	Non Resident	Agent	Health	8/17/2001	10/31/2024
* 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
Administrator	08/15/2024	10/31/2024
Agent	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Heritage Life Insurance Company	300272	Agent - Health	5/20/2022
Active	American Heritage Life Insurance Company	300272	Agent - Life	5/20/2022
Active	Boston Mutual Life Insurance Company	300143	Agent - Health	9/24/2001
Active	Boston Mutual Life Insurance Company	300143	Agent - Life	2/24/2009
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
Active	Security Mutual Life Insurance Company of NY	300708	Agent - Health	1/16/2020
Active	Security Mutual Life Insurance Company of NY	300708	Agent - Life	1/16/2020
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
Active	Aon Consulting Inc NJ	399932	Agent - Health	6/1/2020
Active	Aon Consulting Inc NJ	399932	Agent - Life	6/1/2020
Denied	Aon Consulting Inc NJ	399932	Agent - Casualty
Denied	Aon Consulting Inc NJ	399932	Agent - Property
Active	Farmington Administrative Services LLC	564133	Administrator - Not Applicable	1/24/2019
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