DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Derouin, Brian E	DOIID	614895	NAIC NPN	362323

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/1/2005	5/16/2014
Inactive	Non Resident	Agent	Property	9/1/2005	5/16/2014
Inactive	Non Resident	Agent	Casualty	9/1/2005	5/16/2014
* 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	Markel Insurance Company	301475	Agent - Casualty	10/26/2005	11/3/2011
Inactive	Markel Insurance Company	301475	Agent - Health	10/26/2005	11/3/2011
Inactive	Markel Insurance Company	301475	Agent - Property	10/26/2005	11/3/2011
Inactive	NOVA Casualty Company	622806	Agent - Casualty	8/12/2013	5/16/2014
Inactive	NOVA Casualty Company	622806	Agent - Property	8/12/2013	5/16/2014
Inactive	Rural Community Insurance Company	301891	Agent - Casualty	10/28/2009	5/16/2014
Inactive	Rural Community Insurance Company	301891	Agent - Property	10/28/2009	5/16/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Safehold Special Risk, Inc	658217	Agent - Health
Inactive	Safehold Special Risk, Inc	658217	Agent - Property	9/21/2012	5/16/2014
Inactive	Safehold Special Risk, Inc	658217	Agent - Casualty	9/21/2012	5/16/2014
Denied	Wells Fargo Ins Services Northwest Inc	608327	Agent - Health
Denied	Wells Fargo Ins Services Northwest Inc	608327	Agent - Property
Denied	Wells Fargo Ins Services Northwest Inc	608327	Agent - Casualty