DEPARTMENT OF INSURANCE

Affiliations

Name	Hazlett, Amy Dawn	DOIID	568997	NAIC NPN	7682017

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Life	5/21/2003	7/31/2025
Active	Resident	Agent	Property	5/14/2003	7/31/2025
Active	Resident	Agent	Variable Life and Variable Annuities	3/3/2017	7/31/2025
Active	Resident	Agent	Casualty	5/14/2003	7/31/2025
Active	Resident	Agent	Health	5/21/2003	7/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE American Insurance Company	300625	Agent - Casualty	5/22/2014
Active	ACE American Insurance Company	300625	Agent - Property	5/22/2014
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	5/22/2014	10/10/2020
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - Property	5/22/2014	10/10/2020
Inactive	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	5/22/2014	10/10/2020
Inactive	ACE Property and Casualty Insurance Company	300520	Agent - Property	5/22/2014	10/10/2020
Inactive	Allstate Indemnity Company	300778	Agent - Casualty	4/15/2014	9/30/2022
Inactive	Allstate Indemnity Company	300778	Agent - Property	4/15/2014	9/30/2022
Inactive	Allstate Insurance Company	300773	Agent - Casualty	4/15/2014	9/30/2022
Inactive	Allstate Insurance Company	300773	Agent - Property	4/15/2014	9/30/2022
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	4/15/2014	9/30/2022
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	4/15/2014	9/30/2022
Inactive	Allstate Vehicle & Property Insurance Company	301429	Agent - Casualty	4/15/2014	9/30/2022
Inactive	Allstate Vehicle & Property Insurance Company	301429	Agent - Property	4/15/2014	9/30/2022
Active	AmGUARD Insurance Company	500010	Agent - Casualty	11/16/2022
Active	AmGUARD Insurance Company	500010	Agent - Property	11/16/2022
Active	American Economy Insurance Company	300315	Agent - Casualty	10/27/2022
Active	American Economy Insurance Company	300315	Agent - Property	10/27/2022
Active	American Heritage Life Insurance Company	300272	Agent - Health	1/18/2023
Active	American Heritage Life Insurance Company	300272	Agent - Life	1/18/2023
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	10/11/2016	10/3/2022
Inactive	American Modern Home Insurance Company	300791	Agent - Property	10/11/2016	10/3/2022
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	10/23/2018
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Property	10/23/2018
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	4/15/2016	11/14/2021
Inactive	American Modern Select Insurance Company	581481	Agent - Property	4/15/2016	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	10/11/2016	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	10/11/2016	11/14/2021
Inactive	Assurity Life Insurance Company	301099	Agent - Health	3/31/2015	12/19/2018
Inactive	Assurity Life Insurance Company	301099	Agent - Life	3/31/2015	12/19/2018
Active	Bristol West Insurance Company	301655	Agent - Casualty	10/3/2022
Active	Bristol West Insurance Company	301655	Agent - Property	10/3/2022
Active	Dairyland Insurance Company	301370	Agent - Casualty	1/3/2023
Active	Dairyland Insurance Company	301370	Agent - Property	1/3/2023
Inactive	Esurance Property and Casualty Insurance Company	613279	Agent - Casualty	7/16/2021	9/30/2022
Inactive	Esurance Property and Casualty Insurance Company	613279	Agent - Property	7/16/2021	9/30/2022
Inactive	Everlake Assurance Company	300203	Agent - Life	12/17/2014	9/30/2022
Inactive	Everlake Assurance Company	300203	Agent - Variable Life and Variable Annuities	4/18/2017	9/30/2022
Inactive	Everlake Life Insurance Company	300873	Agent - Health	4/15/2014	9/30/2022
Inactive	Everlake Life Insurance Company	300873	Agent - Life	4/15/2014	9/30/2022
Inactive	Everlake Life Insurance Company	300873	Agent - Variable Life and Variable Annuities	4/18/2017	9/30/2022
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	10/3/2022
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	10/3/2022
Active	Gerber Life Insurance Company	300529	Agent - Health	1/25/2023
Active	Gerber Life Insurance Company	300529	Agent - Life	1/25/2023
Active	Grange Indemnity Insurance Company	300793	Agent - Casualty	9/19/2022
Active	Grange Indemnity Insurance Company	300793	Agent - Property	9/19/2022
Active	Grange Insurance Company	300234	Agent - Casualty	9/19/2022
Active	Grange Insurance Company	300234	Agent - Property	9/19/2022
Active	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	9/19/2022
Active	Grange Property & Casualty Insurance Company	601680	Agent - Property	9/19/2022
Active	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	2/7/2024
Active	Hartford Insurance Company of the Midwest	301918	Agent - Property	2/7/2024
Active	Hartford Underwriters Insurance Company	301064	Agent - Casualty	2/6/2024
Active	Hartford Underwriters Insurance Company	301064	Agent - Property	2/6/2024
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/9/2005	9/7/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	11/9/2005	9/7/2012
Active	Indemnity Insurance Company of North America	301760	Agent - Casualty	5/22/2014
Active	Indemnity Insurance Company of North America	301760	Agent - Property	5/22/2014
Active	Integon General Insurance Corporation	301186	Agent - Casualty	4/28/2022
Active	Integon General Insurance Corporation	301186	Agent - Property	4/28/2022
Active	Integon Indemnity Corporation	300674	Agent - Casualty	8/15/2023
Active	Integon Indemnity Corporation	300674	Agent - Property	8/15/2023
Active	Kentucky National Insurance Company	301625	Agent - Casualty	10/24/2022
Active	Kentucky National Insurance Company	301625	Agent - Property	10/24/2022
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	4/15/2014	9/30/2022
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	4/15/2014	9/30/2022
Inactive	Lincoln Benefit Life Company	301110	Agent - Variable Life and Variable Annuities	4/18/2017	9/30/2022
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	7/10/2015	8/22/2016
Active	National General Insurance Company	300152	Agent - Casualty	7/12/2021
Active	National General Insurance Company	300152	Agent - Property	7/12/2021
Active	NorGUARD Insurance Company	500015	Agent - Casualty	11/16/2022
Active	Ohio Security Insurance Company	300622	Agent - Casualty	10/19/2023
Active	Ohio Security Insurance Company	300622	Agent - Property	10/19/2023
Active	Old American Insurance Company	300762	Agent - Life	1/25/2023
Inactive	Protective Life Insurance Company	300638	Agent - Health	8/8/2021	11/23/2023
Inactive	Protective Life Insurance Company	300638	Agent - Life	8/8/2021	11/23/2023
Inactive	Protective Life Insurance Company	300638	Agent - Variable Life and Variable Annuities	8/8/2021	11/23/2023
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	10/27/2022
Active	SAFECO Insurance Company of America	300159	Agent - Property	10/27/2022
Active	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	10/27/2022
Active	SAFECO Insurance Company of Illinois	301350	Agent - Property	10/27/2022
Active	Sentinel Insurance Company, Limited	501696	Agent - Casualty	1/24/2024
Active	Sentinel Insurance Company, Limited	501696	Agent - Property	1/24/2024
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	6/2/2023
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	6/2/2023
Inactive	State Farm Fire and Casualty Company	301809	Agent - Casualty	5/14/2003	2/27/2014
Inactive	State Farm Fire and Casualty Company	301809	Agent - Property	5/14/2003	2/27/2014
Inactive	State Farm General Insurance Company	301122	Agent - Casualty	5/14/2003	11/23/2010
Inactive	State Farm General Insurance Company	301122	Agent - Property	5/14/2003	11/23/2010
Inactive	State Farm Life Insurance Company	301810	Agent - Life	5/21/2003	2/27/2014
Inactive	State Farm Mutual Automobile Insurance Company	301732	Agent - Casualty	5/14/2003	2/27/2014
Inactive	State Farm Mutual Automobile Insurance Company	301732	Agent - Health	5/21/2003	2/27/2014
Denied	Time Insurance Company	300683	Agent - Health
Active	Trexis Insurance Corporation	599902	Agent - Casualty	6/17/2024
Active	Trexis One Insurance Corporation	684197	Agent - Casualty	6/17/2024
Active	Trustgard Insurance Company	300104	Agent - Casualty	9/19/2022
Active	Trustgard Insurance Company	300104	Agent - Property	9/19/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Amy D. Hazlett Insurance Agency Inc.	1227847	Agent - Casualty	9/6/2022
Active	Amy D. Hazlett Insurance Agency Inc.	1227847	Agent - Health	9/6/2022
Active	Amy D. Hazlett Insurance Agency Inc.	1227847	Agent - Life	9/6/2022
Active	Amy D. Hazlett Insurance Agency Inc.	1227847	Agent - Property	9/6/2022
Inactive	Jason E Todd Insurance Agency Inc.	561449	Agent - Casualty	1/27/2004	3/31/2008
Inactive	Jason E Todd Insurance Agency Inc.	561449	Agent - Health	1/27/2004	3/31/2008
Inactive	Jason E Todd Insurance Agency Inc.	561449	Agent - Life	1/27/2004	3/31/2008
Inactive	Jason E Todd Insurance Agency Inc.	561449	Agent - Property	1/27/2004	3/31/2008