DEPARTMENT OF INSURANCE

Affiliations

Name	Fultz, Jeremy Joseph	DOIID	595399	NAIC NPN	5949104

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Casualty	8/15/2005	4/30/2025
Active	Resident	Agent	Life	8/3/2010	4/30/2025
Active	Resident	Agent	Health	11/16/2010	4/30/2025
Active	Resident	Agent	Property	8/15/2005	4/30/2025
* 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
Active	AAA Life Insurance Company	300287	Agent - Health	3/17/2020
Active	AAA Life Insurance Company	300287	Agent - Life	3/17/2020
Active	Acadia Insurance Company	557871	Agent - Casualty	5/10/2017
Active	Acadia Insurance Company	557871	Agent - Property	5/10/2017
Active	American Fire and Casualty Company	300567	Agent - Casualty	12/7/2011
Active	American Fire and Casualty Company	300567	Agent - Property	12/7/2011
Active	American Interstate Insurance Company	301092	Agent - Casualty	10/9/2006
Inactive	American Select Insurance Company	301229	Agent - Casualty	8/25/2006	8/12/2009
Inactive	American Select Insurance Company	301229	Agent - Property	8/25/2006	8/12/2009
Active	Ansur America Insurance Company	520667	Agent - Casualty	7/3/2014
Active	Ansur America Insurance Company	520667	Agent - Property	7/3/2014
Active	BITCO General Insurance Corporation	301305	Agent - Casualty	6/17/2020
Active	BITCO General Insurance Corporation	301305	Agent - Property	6/17/2020
Active	BITCO National Insurance Company	301366	Agent - Casualty	6/17/2020
Active	BITCO National Insurance Company	301366	Agent - Property	6/17/2020
Active	Banner Life Insurance Company	301696	Agent - Life	10/5/2010
Inactive	Bedivere Insurance Company	300710	Agent - Casualty	7/18/2008	1/5/2010
Inactive	Bedivere Insurance Company	300710	Agent - Property	7/18/2008	1/5/2010
Active	BrickStreet Mutual Insurance Company	709251	Agent - Casualty	10/31/2011
Inactive	Bridgefield Casualty Insurance Company	500013	Agent - Casualty	11/15/2007	12/6/2023
Active	BusinessFirst Insurance Company	722488	Agent - Casualty	5/29/2015
Active	ClearPath Insurance Company	979815	Agent - Casualty	2/29/2024
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	8/17/2007	4/26/2024
Inactive	Consolidated Insurance Company	300943	Agent - Property	8/17/2007	4/26/2024
Active	Continental Western Insurance Company	300576	Agent - Casualty	5/10/2017
Active	Continental Western Insurance Company	300576	Agent - Property	5/10/2017
Inactive	EMC National Life Company	300388	Agent - Health	12/6/2013	3/20/2024
Inactive	EMC National Life Company	300388	Agent - Life	12/6/2013	3/20/2024
Active	EMC Property & Casualty Company	955217	Agent - Casualty	5/24/2021
Active	EMC Property & Casualty Company	955217	Agent - Property	5/24/2021
Active	EMCASCO Insurance Company	842790	Agent - Casualty	2/12/2015
Active	EMCASCO Insurance Company	842790	Agent - Property	2/12/2015
Active	Employers Insurance Company of Wausau	301813	Agent - Casualty	12/6/2010
Active	Employers Insurance Company of Wausau	301813	Agent - Property	12/6/2010
Active	Employers Mutual Casualty Company	300202	Agent - Casualty	1/6/2011
Active	Employers Mutual Casualty Company	300202	Agent - Property	1/6/2011
Inactive	Employers' Fire Insurance Company (The)	301255	Agent - Casualty	7/18/2008	1/5/2010
Inactive	Employers' Fire Insurance Company (The)	301255	Agent - Property	7/18/2008	1/5/2010
Active	FCCI Insurance Company	557454	Agent - Casualty	8/23/2005
Active	FCCI Insurance Company	557454	Agent - Property	8/23/2005
Active	FFVA Mutual Insurance Company	552456	Agent - Casualty	5/17/2010
Active	Fidelity and Guaranty Insurance Company	301009	Agent - Casualty	3/16/2023
Active	Fidelity and Guaranty Insurance Company	301009	Agent - Property	3/16/2023
Active	Firemen's Insurance Company of Washington, D.C.	645553	Agent - Casualty	5/10/2017
Active	Firemen's Insurance Company of Washington, D.C.	645553	Agent - Property	5/10/2017
Active	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	12/6/2010
Active	First Liberty Insurance Corporation (The)	301060	Agent - Property	12/6/2010
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/17/2013	8/29/2018
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/17/2013	8/29/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	4/17/2013	8/29/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	4/17/2013	8/29/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	4/17/2013	8/29/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	4/17/2013	8/29/2018
Active	Frankenmuth Insurance Company	301481	Agent - Casualty	7/3/2014
Active	Frankenmuth Insurance Company	301481	Agent - Property	7/3/2014
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Casualty	1/6/2011	12/15/2017
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Property	1/6/2011	12/15/2017
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	8/19/2008	11/23/2009
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	8/19/2008	11/23/2009
Active	Hartford Casualty Insurance Company	301332	Agent - Casualty	6/17/2018
Active	Hartford Casualty Insurance Company	301332	Agent - Property	6/17/2018
Active	Hartford Fire Insurance Company	300628	Agent - Casualty	12/26/2017
Active	Hartford Fire Insurance Company	300628	Agent - Property	12/26/2017
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	8/19/2008	11/23/2009
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	8/19/2008	11/23/2009
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	8/19/2008	11/10/2009
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	8/19/2008	11/10/2009
Inactive	Indiana Insurance Company	301909	Agent - Casualty	8/17/2007	2/3/2023
Inactive	Indiana Insurance Company	301909	Agent - Property	8/17/2007	2/3/2023
Active	Insurance Company of the West	301520	Agent - Casualty	8/27/2018
Active	Insurance Company of the West	301520	Agent - Property	8/27/2018
Active	LM Insurance Corporation	301061	Agent - Casualty	12/6/2010
Active	LM Insurance Corporation	301061	Agent - Property	12/6/2010
Inactive	Lamorak Insurance Company	301231	Agent - Casualty	1/26/2011	10/17/2012
Inactive	Lamorak Insurance Company	301231	Agent - Property	1/26/2011	10/17/2012
Active	Liberty Insurance Corporation	300444	Agent - Casualty	12/6/2010
Active	Liberty Insurance Corporation	300444	Agent - Property	12/6/2010
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	12/6/2010
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Property	12/6/2010
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	12/6/2010
Active	Liberty Mutual Insurance Company	301159	Agent - Property	12/6/2010
Active	Meridian Security Insurance Company	300423	Agent - Casualty	3/6/2020
Active	Meridian Security Insurance Company	300423	Agent - Property	3/6/2020
Active	Monroe Guaranty Insurance Company	300771	Agent - Casualty	8/23/2005
Active	Monroe Guaranty Insurance Company	300771	Agent - Property	8/23/2005
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Casualty	5/1/2019
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Property	5/1/2019
Active	Motorists Mutual Insurance Company	300963	Agent - Casualty	3/27/2014
Active	Motorists Mutual Insurance Company	300963	Agent - Property	3/27/2014
Active	National Trust Insurance Company	300367	Agent - Casualty	8/23/2005
Active	National Trust Insurance Company	300367	Agent - Property	8/23/2005
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	5/19/2014
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	8/17/2007	4/26/2024
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	8/17/2007	4/26/2024
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	7/19/2015	1/5/2017
Active	NorthStone Insurance Company	818905	Agent - Casualty	1/13/2014
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	12/7/2011
Active	Ohio Casualty Insurance Company	301492	Agent - Property	12/7/2011
Inactive	Ohio Farmers Insurance Company	301667	Agent - Casualty	8/25/2006	8/12/2009
Inactive	Ohio Farmers Insurance Company	301667	Agent - Property	8/25/2006	8/12/2009
Active	Ohio Security Insurance Company	300622	Agent - Casualty	12/7/2011
Active	Ohio Security Insurance Company	300622	Agent - Property	12/7/2011
Inactive	Old Guard Insurance Company	533854	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Old Guard Insurance Company	533854	Agent - Property	6/2/2021	6/11/2021
Active	Old Republic Insurance Company	301225	Agent - Casualty	12/11/2020
Active	Peerless Indemnity Insurance Company	571682	Agent - Casualty	8/17/2007
Active	Peerless Indemnity Insurance Company	571682	Agent - Property	8/17/2007
Active	Peerless Insurance Company	301910	Agent - Casualty	8/17/2007
Active	Peerless Insurance Company	301910	Agent - Property	8/17/2007
Active	PinnaclePoint Insurance Company	819085	Agent - Casualty	1/13/2014
Inactive	Pruco Life Insurance Company	300954	Agent - Health	9/6/2011	12/23/2014
Inactive	Pruco Life Insurance Company	300954	Agent - Life	9/6/2011	12/23/2014
Active	Selective Insurance Company of America	500018	Agent - Casualty	11/14/2016
Active	Selective Insurance Company of America	500018	Agent - Property	11/14/2016
Active	Selective Insurance Company of South Carolina	500012	Agent - Casualty	11/14/2016
Active	Selective Insurance Company of South Carolina	500012	Agent - Property	11/14/2016
Active	Selective Insurance Company of the Southeast	300381	Agent - Casualty	11/14/2016
Active	Selective Insurance Company of the Southeast	300381	Agent - Property	11/14/2016
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	8/19/2008	11/10/2009
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	8/19/2008	11/10/2009
Inactive	Silver Oak Casualty, Inc.	517101	Agent - Casualty	10/9/2006	11/23/2010
Inactive	Silver Oak Casualty, Inc.	517101	Agent - Property	10/9/2006	11/23/2010
Active	State Auto Property & Casualty Insurance Company	301953	Agent - Casualty	3/6/2020
Active	State Auto Property & Casualty Insurance Company	301953	Agent - Property	3/6/2020
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	3/6/2020
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	3/6/2020
Active	SummitPoint Insurance Company	819084	Agent - Casualty	1/13/2014
Active	Tri-State Insurance Company of Minnesota	663528	Agent - Casualty	5/10/2017
Active	Tri-State Insurance Company of Minnesota	663528	Agent - Property	5/10/2017
Active	Trumbull Insurance Company	300242	Agent - Casualty	12/14/2017
Active	Trumbull Insurance Company	300242	Agent - Property	12/14/2017
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	8/19/2008	11/10/2009
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	8/19/2008	11/10/2009
Active	Union Insurance Company	547433	Agent - Casualty	5/10/2017
Active	Union Insurance Company	547433	Agent - Property	5/10/2017
Active	Union Insurance Company of Providence	842791	Agent - Casualty	2/12/2015
Active	Union Insurance Company of Providence	842791	Agent - Property	2/12/2015
Inactive	Wausau Business Insurance Company	301476	Agent - Casualty	12/6/2010	3/31/2015
Inactive	Wausau Business Insurance Company	301476	Agent - Property	12/6/2010	3/31/2015
Inactive	Wausau Underwriters Insurance Company	301105	Agent - Casualty	12/6/2010	8/31/2015
Inactive	Wausau Underwriters Insurance Company	301105	Agent - Property	12/6/2010	8/31/2015
Active	West American Insurance Company	301112	Agent - Casualty	12/7/2011
Active	West American Insurance Company	301112	Agent - Property	12/7/2011
Inactive	Westfield Champion Insurance Company	1054839	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Champion Insurance Company	1054839	Agent - Property	6/2/2021	6/11/2021
Active	Westfield Insurance Company	301950	Agent - Casualty	8/25/2006
Active	Westfield Insurance Company	301950	Agent - Property	8/25/2006
Inactive	Westfield National Insurance Company	301036	Agent - Casualty	8/25/2006	8/12/2009
Inactive	Westfield National Insurance Company	301036	Agent - Property	8/25/2006	8/12/2009
Inactive	Westfield Premier Insurance Company	1055055	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Premier Insurance Company	1055055	Agent - Property	6/2/2021	6/11/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Property	6/2/2021	6/11/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Casualty	6/2/2021	6/11/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Property	6/2/2021	6/11/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	Aaa Life Agency LLC	1063780	Agent - Life	3/23/2021
Active	Aaa Life Agency LLC	1063780	Agent - Health	3/23/2021
Active	Energy Ins Agency Inc	398833	Agent - Casualty	8/15/2005
Active	Energy Ins Agency Inc	398833	Agent - Property	8/15/2005
Active	Energy Ins Agency Inc	398833	Agent - Life	10/5/2010