DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	ADI Brokerage, LLC	DOIID	600726	NAIC NPN	8345717

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	1/4/2005	9/25/2006
Inactive	Resident	Agent	Health	1/4/2005	9/25/2006
* 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	Fidelity & Guaranty Life Insurance Company	301359	Agent - Health	1/27/2005	9/25/2006
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	1/27/2005	9/25/2006
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Health	1/12/2005	9/25/2006
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Life	1/12/2005	9/25/2006

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Costellow, Wayburn Allen	347664	Agent - Health	1/25/2005	9/25/2006
Inactive	Costellow, Wayburn Allen	347664	Agent - Life	1/25/2005	9/25/2006
Inactive	Watson, William Todd	333502	Agent - Health	1/4/2005	9/25/2006
Inactive	Watson, William Todd	333502	Agent - Life	1/4/2005	9/25/2006