DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Tom, Regina Joanne	DOIID	592987	NAIC NPN	3542621

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Adjuster	Independent	12/9/2004	7/1/2010
Active	Non Resident	Independent Adjuster	Workers' Compensation	8/10/2012		9/30/2025
Inactive	Resident	Staff Adjuster	Workers' Compensation	7/1/2010	9/30/2011
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Brentwood Serv Administrators Inc	397924	Independent Adjuster - Workers' Compensation	3/8/2017