DEPARTMENT OF INSURANCE

Affiliations

Name	Black, William Adams	DOIID	593230	NAIC NPN	5423620

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	4/21/2011		2/28/2026
Active	Non Resident	Agent	Health	4/21/2011		2/28/2026
Active	Non Resident	Agent	Property	7/30/2004		2/28/2026
Active	Non Resident	Agent	Casualty	7/30/2004		2/28/2026
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	7/30/2004	2/29/2012
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	12/15/2025	02/28/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	11/26/2008
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Property	11/26/2008
Active	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	8/30/2005
Active	ACE Property and Casualty Insurance Company	300520	Agent - Property	8/30/2005
Inactive	AXA Insurance Company	301046	Agent - Casualty	11/29/2018	2/2/2022
Inactive	AXA Insurance Company	301046	Agent - Property	11/29/2018	2/2/2022
Inactive	American Family Home Insurance Company	301817	Agent - Casualty	6/11/2009	12/17/2019
Inactive	American Family Home Insurance Company	301817	Agent - Property	6/11/2009	12/17/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	6/11/2009	12/17/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Property	6/11/2009	12/17/2019
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	6/30/2009	12/17/2019
Inactive	American Southern Home Insurance Company	626276	Agent - Property	6/30/2009	12/17/2019
Active	Bankers Standard Insurance Company	301620	Agent - Casualty	8/29/2006
Active	Bankers Standard Insurance Company	301620	Agent - Property	8/29/2006
Inactive	Encompass Indemnity Company	546376	Agent - Casualty	6/24/2005	4/25/2007
Inactive	Encompass Indemnity Company	546376	Agent - Property	6/24/2005	4/25/2007
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	9/16/2015	8/17/2017
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	9/16/2015	8/17/2017
Inactive	Jewelers Mutual Insurance Company, SI	301935	Agent - Casualty	12/27/2006	9/28/2017
Inactive	Jewelers Mutual Insurance Company, SI	301935	Agent - Property	12/27/2006	9/28/2017
Active	Pacific Employers Insurance Company	301753	Agent - Casualty	11/26/2008
Active	Pacific Employers Insurance Company	301753	Agent - Property	11/26/2008
Inactive	RLI Insurance Company	301217	Agent - Casualty	10/14/2004	2/25/2015
Inactive	RLI Insurance Company	301217	Agent - Property	10/14/2004	2/25/2015
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	10/23/2012	12/17/2014
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	10/23/2012	12/17/2014
Active	XL Specialty Insurance Company	301605	Agent - Casualty	11/12/2020
Active	XL Specialty Insurance Company	301605	Agent - Property	11/12/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ap Intego Insurance Group, LLC	602304	Agent - Casualty	1/31/2005	2/16/2017
Inactive	Ap Intego Insurance Group, LLC	602304	Agent - Property	1/31/2005	2/16/2017
Inactive	Ap Intego Insurance Group, LLC	602304	Agent - Life	6/25/2013	2/16/2017
Inactive	Ap Intego Insurance Group, LLC	602304	Agent - Health	6/25/2013	2/16/2017
Active	Zillion Insurance Services	997741	Agent - Casualty	6/14/2018
Active	Zillion Insurance Services	997741	Agent - Property	6/14/2018