DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Domzalski, Robert Ernest	DOIID	613323	NAIC NPN	2059660

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	8/4/2005	3/1/2008
Inactive	Resident	Agent	Health	8/4/2005	3/1/2008
Inactive	Resident	Agent	Casualty	8/4/2005	3/1/2008
Inactive	Resident	Agent	Property	8/4/2005	3/1/2008
* 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	Consolidated Insurance Company	300943	Agent - Casualty	3/16/2006	3/1/2008
Inactive	Consolidated Insurance Company	300943	Agent - Property	3/16/2006	3/1/2008
Inactive	Indiana Insurance Company	301909	Agent - Casualty	3/16/2006	3/1/2008
Inactive	Indiana Insurance Company	301909	Agent - Property	3/16/2006	3/1/2008
Inactive	Lumbermen's Underwriting Alliance	300917	Agent - Casualty	9/9/2005	5/18/2006
Inactive	Lumbermen's Underwriting Alliance	300917	Agent - Property	9/9/2005	5/18/2006
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	3/16/2006	3/1/2008
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	3/16/2006	3/1/2008
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	11/7/2007	1/29/2008
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	11/7/2007	1/29/2008
Inactive	Peerless Insurance Company	301910	Agent - Casualty	3/16/2006	3/1/2008
Inactive	Peerless Insurance Company	301910	Agent - Property	3/16/2006	3/1/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	LIG Insurance Agency, Inc.	546391	Agent - Casualty	9/9/2005	5/30/2006
Inactive	LIG Insurance Agency, Inc.	546391	Agent - Property	9/9/2005	5/30/2006