DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Wade	DOIID	581889	NAIC NPN	7947238

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	12/15/2003	6/30/2013
Inactive	Non Resident	Agent	Property	12/15/2003	6/30/2013
Inactive	Non Resident	Agent	Life	12/15/2003	6/30/2013
Inactive	Non Resident	Agent	Health	12/15/2003	6/30/2013
* 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 Bankers Insurance Company of Florida	300360	Agent - Casualty	2/19/2010	8/28/2010
Inactive	American Bankers Insurance Company of Florida	300360	Agent - Property	2/19/2010	8/28/2010
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Health	2/19/2010	4/23/2012
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Life	2/19/2010	4/23/2012
Inactive	American Family Home Insurance Company	301817	Agent - Casualty	4/20/2004	11/8/2012
Inactive	American Family Home Insurance Company	301817	Agent - Property	4/20/2004	11/8/2012
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	4/20/2004	11/8/2012
Inactive	American Modern Home Insurance Company	300791	Agent - Property	4/20/2004	11/8/2012
Inactive	American Reliable Insurance Company	301889	Agent - Casualty	11/22/2010	4/23/2012
Inactive	American Reliable Insurance Company	301889	Agent - Property	11/22/2010	4/23/2012
Inactive	American Security Insurance Company	300901	Agent - Casualty	11/22/2010	4/23/2012
Inactive	American Security Insurance Company	300901	Agent - Property	11/22/2010	4/23/2012
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	12/12/2006	11/2/2012
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	12/12/2006	11/2/2012
Inactive	Standard Guaranty Insurance Company	300902	Agent - Casualty	11/22/2010	12/20/2011
Inactive	Standard Guaranty Insurance Company	300902	Agent - Property	11/22/2010	12/20/2011
Inactive	Union Security Insurance Company	301844	Agent - Health	2/19/2010	12/8/2010
Inactive	Union Security Insurance Company	301844	Agent - Life	2/19/2010	12/8/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Assurant Insurance Agency, Inc	559398	Agent - Health	7/29/2004	2/14/2010
Inactive	Assurant Insurance Agency, Inc	559398	Agent - Life	7/29/2004	2/14/2010
Inactive	Assurant Insurance Agency, Inc	559398	Agent - Casualty	7/29/2004	4/11/2012
Inactive	Assurant Insurance Agency, Inc	559398	Agent - Property	7/29/2004	4/11/2012