DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Derickson, Brian Keith	DOIID	544345	NAIC NPN	7224073

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	2/11/2002	7/1/2004
Inactive	Resident	Agent	Property	7/25/2018	2/28/2021
Inactive	Resident	Agent	Life	2/11/2002	7/1/2004
Inactive	Resident	Agent	Casualty	7/25/2018	2/28/2021
* 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	Anthem Life Insurance Company	301209	Agent - Health	2/11/2002	7/1/2004
Inactive	Anthem Life Insurance Company	301209	Agent - Life	2/11/2002	7/1/2004
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	4/24/2002	7/1/2004
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	4/24/2002	7/1/2004
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	10/8/2018	9/25/2019
Inactive	Dairyland Insurance Company	301370	Agent - Property	10/8/2018	9/25/2019
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Health	4/24/2002	7/1/2004
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	4/24/2002	7/1/2004
Inactive	Time Insurance Company	300683	Agent - Health	3/8/2002	8/5/2003
Inactive	Time Insurance Company	300683	Agent - Life	3/8/2002	8/5/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	2/19/2002	7/1/2004
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	2/19/2002	7/1/2004
Inactive	Medlink Inc	400721	Agent - Health	3/7/2002	7/1/2004
Inactive	Medlink Inc	400721	Agent - Life	3/7/2002	7/1/2004