DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Commonwealth Risk Management Group, Inc	DOIID	598244	NAIC NPN	8307005

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Denied	Resident	Agent	Personal Lines
Inactive	Resident	Agent	Casualty	12/14/2004	11/5/2008
Inactive	Resident	Agent	Property	12/14/2004	11/5/2008
Inactive	Resident	Agent	Health	11/10/2004	3/31/2010
Inactive	Resident	Agent	Life	11/10/2004	3/31/2010
* 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	Allstate Indemnity Company	300778	Agent - Casualty	6/7/2005	11/5/2008
Inactive	Allstate Indemnity Company	300778	Agent - Property	6/7/2005	11/5/2008
Inactive	Allstate Insurance Company	300773	Agent - Casualty	6/7/2005	11/5/2008
Inactive	Allstate Insurance Company	300773	Agent - Property	6/7/2005	11/5/2008
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	8/12/2005	11/5/2008
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	8/12/2005	11/5/2008
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	12/28/2004	10/15/2008
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	12/28/2004	10/15/2008
Inactive	Everlake Life Insurance Company	300873	Agent - Health	6/8/2005	3/31/2010
Inactive	Everlake Life Insurance Company	300873	Agent - Life	6/8/2005	3/31/2010
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	10/29/2008	3/31/2010
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	10/29/2008	3/31/2010
Inactive	Safety National Casualty Corporation	300390	Agent - Casualty	6/30/2008	11/5/2008
Inactive	Safety National Casualty Corporation	300390	Agent - Property	6/30/2008	11/5/2008

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Bush, Michael W	600407	Agent - Casualty
Denied	Bush, Michael W	600407	Agent - Property
Denied	Hurst, Malia Waits	600410	Agent - Property
Inactive	Roberts, Anthony Scott	332520	Agent - Casualty	12/14/2004	11/4/2008
Inactive	Roberts, Anthony Scott	332520	Agent - Health	11/10/2004	3/31/2010
Inactive	Roberts, Anthony Scott	332520	Agent - Life	11/10/2004	3/31/2010
Inactive	Roberts, Anthony Scott	332520	Agent - Property	12/14/2004	11/4/2008