DEPARTMENT OF INSURANCE

Affiliations

Name	Tubergen, Keith	DOIID	575938	NAIC NPN	983269

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	10/30/2019	4/30/2022
Inactive	Non Resident	Agent	Property	10/30/2019	4/30/2022
Inactive	Non Resident	Agent	Casualty	10/30/2019	4/30/2022
* 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	ACE American Insurance Company	300625	Agent - Casualty	11/25/2019	4/30/2022
Inactive	ACE American Insurance Company	300625	Agent - Property	11/25/2019	4/30/2022
Inactive	Accident Fund General Insurance Company	626282	Agent - Casualty	12/6/2019	4/30/2022
Inactive	Accident Fund General Insurance Company	626282	Agent - Property	12/6/2019	7/26/2020
Inactive	Accident Fund Insurance Company of America	518734	Agent - Casualty	12/6/2019	4/30/2022
Inactive	Accident Fund Insurance Company of America	518734	Agent - Property	12/6/2019	7/26/2020
Inactive	Accident Fund National Insurance Company	626286	Agent - Casualty	12/6/2019	4/30/2022
Inactive	Accident Fund National Insurance Company	626286	Agent - Property	12/6/2019	7/26/2020
Inactive	Bankers Standard Insurance Company	301620	Agent - Casualty	11/25/2019	4/30/2022
Inactive	Bankers Standard Insurance Company	301620	Agent - Property	11/25/2019	4/30/2022
Inactive	BrickStreet Mutual Insurance Company	709251	Agent - Casualty	11/27/2021	11/27/2021
Inactive	Federal Insurance Company	301144	Agent - Casualty	11/25/2019	4/30/2022
Inactive	Federal Insurance Company	301144	Agent - Property	11/25/2019	4/30/2022
Inactive	Insurance Company of the West	301520	Agent - Casualty	11/6/2019	4/30/2022
Inactive	Insurance Company of the West	301520	Agent - Property	11/6/2019	4/30/2022
Inactive	NorthStone Insurance Company	818905	Agent - Casualty	11/27/2021	11/27/2021
Inactive	PinnaclePoint Insurance Company	819085	Agent - Casualty	11/27/2021	11/27/2021
Inactive	SummitPoint Insurance Company	819084	Agent - Casualty	11/27/2021	11/27/2021
Inactive	United Wisconsin Insurance Company	301103	Agent - Casualty	12/6/2019	4/30/2022
Inactive	United Wisconsin Insurance Company	301103	Agent - Property	12/6/2019	7/26/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acrisure LLC	696181	Agent - Casualty	12/18/2019	2/2/2021
Inactive	Acrisure LLC	696181	Agent - Property	12/18/2019	2/2/2021