DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bain, Donna	DOIID	594203	NAIC NPN	8179927

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	8/19/2004	10/31/2008
Inactive	Non Resident	Agent	Health	11/14/2013	11/2/2015
Inactive	Non Resident	Agent	Life	11/14/2013	11/2/2015
Inactive	Non Resident	Agent	Property	8/19/2004	10/31/2008
* 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	CMFG Life Insurance Company	300929	Agent - Health	11/19/2013	3/18/2015
Inactive	CMFG Life Insurance Company	300929	Agent - Life	11/19/2013	3/18/2015
Inactive	Merastar Insurance Company	301363	Agent - Casualty	8/19/2004	2/21/2006
Inactive	Merastar Insurance Company	301363	Agent - Property	8/19/2004	2/21/2006
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	3/20/2007	10/31/2008
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	3/20/2007	10/31/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Insurance Planning & Service Co. Inc.	400509	Agent - Casualty
Denied	Insurance Planning & Service Co. Inc.	400509	Agent - Property