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	Health	11/16/2010	4/30/2027
Active	Resident	Agent	Property	8/15/2005	4/30/2027
Active	Resident	Agent	Casualty	8/15/2005	4/30/2027
Active	Resident	Agent	Life	8/3/2010	4/30/2027
* 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	02/15/2025	04/30/2025	02/18/2025	02/18/2025	Yes

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	Allmerica Financial Alliance Insurance Company	300823	Agent - Casualty	12/10/2024
Active	Allmerica Financial Alliance Insurance Company	300823	Agent - Property	12/10/2024
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Casualty	12/10/2024
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Property	12/10/2024
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
Active	Hanover American Insurance Company (The)	300447	Agent - Casualty	12/10/2024
Active	Hanover American Insurance Company (The)	300447	Agent - Property	12/10/2024
Active	Hanover Insurance Company (The)	300508	Agent - Casualty	12/10/2024
Active	Hanover Insurance Company (The)	300508	Agent - Property	12/10/2024
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	Massachusetts Bay Insurance Company	300898	Agent - Casualty	12/10/2024
Active	Massachusetts Bay Insurance Company	300898	Agent - Property	12/10/2024
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
Active	Verlan Fire Insurance Company	517102	Agent - Casualty	12/10/2024
Active	Verlan Fire Insurance Company	517102	Agent - Property	12/10/2024
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