DEPARTMENT OF INSURANCE

Affiliations

Name	Douglas, David	DOIID	595510	NAIC NPN	8226955

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Health	9/21/2004	11/30/2025
Active	Resident	Agent	Casualty	3/31/2005	11/30/2025
Active	Resident	Agent	Property	3/31/2005	11/30/2025
Active	Resident	Agent	Life	9/21/2004	11/30/2025
Active	Resident	Surplus Lines Broker	Not Applicable	9/29/2020	11/30/2025
* 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	ACE American Insurance Company	300625	Agent - Casualty	6/15/2011
Active	ACE American Insurance Company	300625	Agent - Property	6/15/2011
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	11/22/2014
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Property	11/22/2014
Active	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	11/22/2014
Active	ACE Property and Casualty Insurance Company	300520	Agent - Property	11/22/2014
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	11/23/2010	12/19/2023
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Property	11/23/2010	12/19/2023
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	10/28/2004	11/19/2007
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	10/28/2004	11/19/2007
Active	Allied Eastern Indemnity Company	683842	Agent - Casualty	4/15/2014
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	9/21/2004	6/16/2006
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	9/21/2004	6/16/2006
Active	American Fire and Casualty Company	300567	Agent - Casualty	11/3/2011
Active	American Fire and Casualty Company	300567	Agent - Property	11/3/2011
Active	BITCO General Insurance Corporation	301305	Agent - Casualty	6/5/2009
Active	BITCO General Insurance Corporation	301305	Agent - Property	6/5/2009
Active	BITCO National Insurance Company	301366	Agent - Casualty	6/5/2009
Active	BITCO National Insurance Company	301366	Agent - Property	6/5/2009
Inactive	Berkley National Insurance Company	515028	Agent - Casualty	7/21/2014	10/6/2023
Inactive	Berkley National Insurance Company	515028	Agent - Property	7/21/2014	10/6/2023
Inactive	Berkley Regional Insurance Company	300920	Agent - Casualty	4/17/2014	10/6/2023
Inactive	Berkley Regional Insurance Company	300920	Agent - Property	4/17/2014	10/6/2023
Active	BrickStreet Mutual Insurance Company	709251	Agent - Casualty	2/23/2016
Inactive	Bridgefield Casualty Insurance Company	500013	Agent - Casualty	1/29/2007	12/18/2017
Active	ClearPath Insurance Company	979815	Agent - Casualty	2/29/2024
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	11/3/2011	4/26/2024
Inactive	Consolidated Insurance Company	300943	Agent - Property	11/3/2011	4/26/2024
Active	Continental Western Insurance Company	300576	Agent - Casualty	5/24/2010
Active	Continental Western Insurance Company	300576	Agent - Property	5/24/2010
Active	Eastern Advantage Assurance Company	692390	Agent - Casualty	4/15/2014
Active	Eastern Alliance Insurance Company	683841	Agent - Casualty	4/15/2014
Active	Employers Insurance Company of Wausau	301813	Agent - Casualty	3/31/2005
Active	Employers Insurance Company of Wausau	301813	Agent - Property	3/31/2005
Active	FCCI Insurance Company	557454	Agent - Casualty	6/18/2009
Active	FCCI Insurance Company	557454	Agent - Property	6/18/2009
Active	Fireman's Fund Insurance Company	301423	Agent - Casualty	10/23/2020
Active	Fireman's Fund Insurance Company	301423	Agent - Property	10/23/2020
Active	Firemen's Insurance Company of Washington, D.C.	645553	Agent - Casualty	5/24/2010
Active	Firemen's Insurance Company of Washington, D.C.	645553	Agent - Property	5/24/2010
Active	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	4/29/2009
Active	First Liberty Insurance Corporation (The)	301060	Agent - Property	4/29/2009
Inactive	GuideOne Elite Insurance Company	300490	Agent - Casualty	1/14/2020	6/21/2024
Inactive	GuideOne Elite Insurance Company	300490	Agent - Property	1/14/2020	6/21/2024
Inactive	GuideOne Insurance Company	301794	Agent - Casualty	1/14/2020	6/21/2024
Inactive	GuideOne Insurance Company	301794	Agent - Property	1/14/2020	6/21/2024
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Casualty	1/14/2020	6/21/2024
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Property	1/14/2020	6/21/2024
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	4/21/2008	11/5/2008
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	4/21/2008	11/5/2008
Inactive	Hartford Casualty Insurance Company	301332	Agent - Casualty	4/21/2008	11/5/2008
Inactive	Hartford Casualty Insurance Company	301332	Agent - Property	4/21/2008	11/5/2008
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	3/24/2016	8/18/2017
Active	Hartford Fire Insurance Company	300628	Agent - Health	4/23/2020
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	3/24/2016	8/18/2017
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	4/21/2008	11/23/2009
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	4/21/2008	11/23/2009
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	5/7/2020
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	5/7/2020
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	4/21/2008	11/5/2008
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	4/21/2008	11/5/2008
Active	Indemnity Insurance Company of North America	301760	Agent - Casualty	2/21/2014
Active	Indemnity Insurance Company of North America	301760	Agent - Property	2/21/2014
Inactive	Indiana Insurance Company	301909	Agent - Casualty	11/3/2011	2/3/2023
Inactive	Indiana Insurance Company	301909	Agent - Property	11/3/2011	2/3/2023
Active	Insurance Company of the West	301520	Agent - Casualty	8/23/2019
Active	Insurance Company of the West	301520	Agent - Property	8/23/2019
Active	LM Insurance Corporation	301061	Agent - Casualty	4/29/2009
Active	LM Insurance Corporation	301061	Agent - Property	4/29/2009
Active	Liberty Insurance Corporation	300444	Agent - Casualty	4/29/2009
Active	Liberty Insurance Corporation	300444	Agent - Property	4/29/2009
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	12/21/2006
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Property	12/21/2006
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	12/21/2006
Active	Liberty Mutual Insurance Company	301159	Agent - Property	12/21/2006
Inactive	Lincoln Life Assurance Company of Boston	301915	Agent - Health	4/1/2005	10/10/2019
Inactive	Lincoln Life Assurance Company of Boston	301915	Agent - Life	4/1/2005	10/10/2019
Active	Monroe Guaranty Insurance Company	300771	Agent - Casualty	6/18/2009
Active	Monroe Guaranty Insurance Company	300771	Agent - Property	6/18/2009
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Casualty	6/1/2019
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Property	6/1/2019
Active	National Trust Insurance Company	300367	Agent - Casualty	6/18/2009
Active	National Trust Insurance Company	300367	Agent - Property	6/18/2009
Active	Nationwide Agribusiness Insurance Company	301008	Agent - Casualty	6/27/2012
Active	Nationwide Agribusiness Insurance Company	301008	Agent - Property	6/27/2012
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	11/3/2011	4/26/2024
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	11/3/2011	4/26/2024
Active	NorthStone Insurance Company	818905	Agent - Casualty	2/23/2016
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	11/3/2011
Active	Ohio Casualty Insurance Company	301492	Agent - Property	11/3/2011
Active	Ohio Security Insurance Company	300622	Agent - Casualty	11/3/2011
Active	Ohio Security Insurance Company	300622	Agent - Property	11/3/2011
Inactive	Old Guard Insurance Company	533854	Agent - Casualty	6/7/2021	6/11/2021
Inactive	Old Guard Insurance Company	533854	Agent - Property	6/7/2021	6/11/2021
Active	Pacific Employers Insurance Company	301753	Agent - Casualty	11/22/2014
Active	Pacific Employers Insurance Company	301753	Agent - Property	11/22/2014
Active	Peerless Indemnity Insurance Company	571682	Agent - Casualty	11/3/2011
Active	Peerless Indemnity Insurance Company	571682	Agent - Property	11/3/2011
Active	Peerless Insurance Company	301910	Agent - Casualty	11/3/2011
Active	Peerless Insurance Company	301910	Agent - Property	11/3/2011
Active	Penn Millers Insurance Company	301584	Agent - Casualty	6/7/2013
Active	Penn Millers Insurance Company	301584	Agent - Property	6/7/2013
Active	PinnaclePoint Insurance Company	819085	Agent - Casualty	2/23/2016
Inactive	Plaza Insurance Company	300748	Agent - Casualty	12/16/2016	12/16/2021
Active	Selective Insurance Company of America	500018	Agent - Casualty	1/15/2022
Active	Selective Insurance Company of America	500018	Agent - Property	1/15/2022
Active	Selective Insurance Company of South Carolina	500012	Agent - Casualty	1/15/2022
Active	Selective Insurance Company of South Carolina	500012	Agent - Property	1/15/2022
Active	Selective Insurance Company of the Southeast	300381	Agent - Casualty	1/15/2022
Active	Selective Insurance Company of the Southeast	300381	Agent - Property	1/15/2022
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	4/21/2008	11/11/2009
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	4/21/2008	11/11/2009
Inactive	StarNet Insurance Company	502746	Agent - Casualty	7/22/2015	10/6/2023
Inactive	StarNet Insurance Company	502746	Agent - Property	7/22/2015	10/6/2023
Active	SummitPoint Insurance Company	819084	Agent - Casualty	2/23/2016
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	4/21/2008	11/11/2009
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	4/21/2008	11/11/2009
Inactive	Underwriters at Lloyd's, London	300658	Agent - Casualty	4/12/2019	12/18/2023
Inactive	Underwriters at Lloyd's, London	300658	Agent - Property	4/12/2019	12/18/2023
Active	Union Insurance Company	547433	Agent - Casualty	5/24/2010
Active	Union Insurance Company	547433	Agent - Property	5/24/2010
Inactive	Wausau Business Insurance Company	301476	Agent - Casualty	3/31/2005	3/31/2015
Inactive	Wausau Business Insurance Company	301476	Agent - Property	3/31/2005	3/31/2015
Inactive	Wausau Underwriters Insurance Company	301105	Agent - Casualty	3/31/2005	2/4/2022
Inactive	Wausau Underwriters Insurance Company	301105	Agent - Property	3/31/2005	2/4/2022
Active	West American Insurance Company	301112	Agent - Casualty	11/3/2011
Active	West American Insurance Company	301112	Agent - Property	11/3/2011
Inactive	West Bend Insurance Company	672974	Agent - Casualty	8/24/2018	5/6/2024
Inactive	West Bend Insurance Company	672974	Agent - Property	8/24/2018	5/6/2024
Active	Westchester Fire Insurance Company	300990	Agent - Casualty	5/25/2011
Active	Westchester Fire Insurance Company	300990	Agent - Property	5/25/2011
Inactive	Westfield Champion Insurance Company	1054839	Agent - Casualty	6/7/2021	6/11/2021
Inactive	Westfield Champion Insurance Company	1054839	Agent - Property	6/7/2021	6/11/2021
Active	Westfield Insurance Company	301950	Agent - Casualty	11/7/2013
Active	Westfield Insurance Company	301950	Agent - Property	11/7/2013
Inactive	Westfield Premier Insurance Company	1055055	Agent - Casualty	6/7/2021	6/11/2021
Inactive	Westfield Premier Insurance Company	1055055	Agent - Property	6/7/2021	6/11/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Casualty	6/7/2021	6/11/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Property	6/7/2021	6/11/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Casualty	6/7/2021	6/11/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Property	6/7/2021	6/11/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Health	5/28/2009	10/10/2019
Inactive	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Life	5/28/2009	10/10/2019
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Casualty	5/28/2009
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Property	5/28/2009
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Surplus Lines Broker - Not Applicable	10/12/2020
Inactive	Wausau Signature Agency L L C	697549	Agent - Health	1/20/2009	7/31/2009
Inactive	Wausau Signature Agency L L C	697549	Agent - Life	1/20/2009	7/31/2009
Inactive	Wausau Signature Agency L L C	697549	Agent - Casualty	1/20/2009	7/31/2009
Inactive	Wausau Signature Agency L L C	697549	Agent - Property	1/20/2009	7/31/2009
Inactive	Wausau Signature Agency, LLC	399369	Agent - Health	8/5/2005	3/16/2009
Inactive	Wausau Signature Agency, LLC	399369	Agent - Life	8/5/2005	3/16/2009
Inactive	Wausau Signature Agency, LLC	399369	Agent - Casualty	8/5/2005	3/16/2009
Inactive	Wausau Signature Agency, LLC	399369	Agent - Property	8/5/2005	3/16/2009