DEPARTMENT OF INSURANCE

Affiliations

Name	Custom Benefit Programs Inc DBA : Univers Workplace Solutions	DOIID	630774	NAIC NPN	1992094

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	12/4/2009	3/31/2026
Active	Non Resident	Agent	Health	8/16/2006	3/31/2026
Active	Non Resident	Agent	Property	12/4/2009	3/31/2026
Active	Non Resident	Agent	Life	8/16/2006	3/31/2026
* 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 Property and Casualty Insurance Company	300520	Agent - Health	12/30/2019
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/23/2022
Active	Aetna Life Insurance Company	301140	Agent - Health	9/23/2022
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	11/2/2009
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	11/2/2009
Active	American Heritage Life Insurance Company	300272	Agent - Health	11/11/2021
Active	American Heritage Life Insurance Company	300272	Agent - Life	11/11/2021
Active	American Pet Insurance Company, Inc.	301240	Agent - Casualty	1/7/2022
Active	American Pet Insurance Company, Inc.	301240	Agent - Property	1/7/2022
Active	Boston Mutual Life Insurance Company	300143	Agent - Health	5/5/2010
Active	Boston Mutual Life Insurance Company	300143	Agent - Life	5/5/2010
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	11/2/2009
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	11/2/2009
Active	Combined Insurance Company of America	301472	Agent - Health	5/14/2015
Active	Combined Insurance Company of America	301472	Agent - Life	5/14/2015
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	12/10/2012	12/10/2018
Active	Continental American Insurance Company	301700	Agent - Health	9/29/2008
Active	Continental American Insurance Company	301700	Agent - Life	9/29/2008
Inactive	Continental General Insurance Company	300691	Agent - Health	8/9/2018	1/25/2019
Inactive	Continental General Insurance Company	300691	Agent - Life	8/9/2018	1/25/2019
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	12/10/2012	12/10/2018
Inactive	HM Life Insurance Company	301408	Agent - Health	6/3/2008	4/24/2018
Inactive	HM Life Insurance Company	301408	Agent - Life	6/3/2008	4/24/2018
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	2/4/2021
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	2/4/2021
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	12/10/2012	12/10/2018
Inactive	Humana Insurance Company	301104	Agent - Health	12/10/2012	12/10/2018
Inactive	Humana Insurance Company	301104	Agent - Life	12/10/2012	12/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	12/10/2012	12/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	12/10/2012	12/10/2018
Active	Independence American Insurance Company	524747	Agent - Casualty	6/9/2023
Active	Independence American Insurance Company	524747	Agent - Property	6/9/2023
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/11/2008	8/9/2018
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/11/2008	8/9/2018
Active	Life Insurance Company of North America	300711	Agent - Health	9/30/2019
Active	Life Insurance Company of North America	300711	Agent - Life	9/30/2019
Active	Lincoln National Life Insurance Company (The)	301382	Agent - Health	6/26/2023
Active	Lincoln National Life Insurance Company (The)	301382	Agent - Life	6/26/2023
Active	Metropolitan Life Insurance Company	301948	Agent - Health	7/5/2022
Active	Metropolitan Life Insurance Company	301948	Agent - Life	7/5/2022
Active	Metropolitan Tower Life Insurance Company	300322	Agent - Health	5/1/2023
Active	Metropolitan Tower Life Insurance Company	300322	Agent - Life	5/1/2023
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	11/6/2006
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	11/6/2006
Active	Prudential Insurance Company of America	300784	Agent - Health	11/11/2020
Active	Prudential Insurance Company of America	300784	Agent - Life	11/11/2020
Active	ReliaStar Life Insurance Company	301712	Agent - Health	12/4/2023
Active	ReliaStar Life Insurance Company	301712	Agent - Life	12/4/2023
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	10/8/2007	11/9/2009
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	10/8/2007	11/9/2009
Active	Starmount Life Insurance Company	628031	Agent - Health	10/8/2021
Active	Transamerica Life Insurance Company	300571	Agent - Health	12/16/2009
Active	Transamerica Life Insurance Company	300571	Agent - Life	12/16/2009
Active	Trustmark Insurance Company	300317	Agent - Health	4/1/2009
Active	Trustmark Insurance Company	300317	Agent - Life	4/1/2009
Active	UNUM Life Insurance Company of America	300817	Agent - Health	11/6/2006
Active	UNUM Life Insurance Company of America	300817	Agent - Life	11/6/2006
Active	United States Fire Insurance Company	582240	Agent - Casualty	9/13/2018
Active	United States Fire Insurance Company	582240	Agent - Property	9/13/2018
Active	Unum Insurance Company	301499	Agent - Health	10/8/2021
Active	Unum Insurance Company	301499	Agent - Life	10/8/2021

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Alvarado, Ivelisse Rivera	1171906	Agent - Health	8/24/2023	2/2/2024
Inactive	Alvarado, Ivelisse Rivera	1171906	Agent - Life	8/24/2023	2/2/2024
Active	Ballard, Tawni M	862382	Agent - Health	2/16/2022
Active	Ballard, Tawni M	862382	Agent - Life	2/16/2022
Inactive	Borajkiewicz, Jeffrey J	881828	Agent - Health	3/24/2022	4/10/2024
Inactive	Borajkiewicz, Jeffrey J	881828	Agent - Life	3/24/2022	4/10/2024
Active	Campana, William W	1138292	Agent - Health	5/22/2023
Active	Campana, William W	1138292	Agent - Life	5/22/2023
Active	Carrico, Ronald Ray	579902	Agent - Health	3/24/2022
Active	Carrico, Ronald Ray	579902	Agent - Life	3/24/2022
Active	Chance, Julia Yurievna	769538	Agent - Health	2/16/2022
Active	Colton, Timothy M	629175	Agent - Health	3/29/2022
Active	Colton, Timothy M	629175	Agent - Life	3/29/2022
Active	Dapelo, Annemarie	1140833	Agent - Health	2/16/2022
Active	Dapelo, Annemarie	1140833	Agent - Life	2/16/2022
Inactive	Farlow, Daniel Jay	789293	Agent - Health	2/13/2024	7/17/2024
Inactive	Farlow, Daniel Jay	789293	Agent - Life	2/13/2024	7/17/2024
Active	Frye, Warren R	306701	Agent - Health	3/29/2022
Active	Frye, Warren R	306701	Agent - Life	3/29/2022
Active	Gitelson, Leonard Roy	882601	Agent - Health	3/24/2022
Active	Gitelson, Leonard Roy	882601	Agent - Life	3/24/2022
Active	Graham, Chanel L	636903	Agent - Health	3/11/2020
Active	Graham, Chanel L	636903	Agent - Life	3/11/2020
Active	Gruvman, Gabriel Omar	319564	Agent - Health	3/24/2022
Active	Gruvman, Gabriel Omar	319564	Agent - Life	3/24/2022
Active	Hand, Claudia Louise	314820	Agent - Health	3/24/2022
Active	Hand, Claudia Louise	314820	Agent - Life	3/24/2022
Active	Hiltner, Eugenia S	1141117	Agent - Health	4/27/2023
Active	Hiltner, Eugenia S	1141117	Agent - Life	4/27/2023
Inactive	Jaspe, Jose	883914	Agent - Health	2/16/2022	8/31/2023
Inactive	Jaspe, Jose	883914	Agent - Life	2/16/2022	8/31/2023
Active	Johnson, Glenn I	682142	Agent - Health	3/24/2022
Active	Johnson, Glenn I	682142	Agent - Life	3/24/2022
Active	Kennedy, Brian D	833022	Agent - Health	2/26/2021
Active	Kennedy, Brian D	833022	Agent - Life	2/26/2021
Active	Ladner, Theresa Dianne	331768	Agent - Health	3/24/2022
Active	Ladner, Theresa Dianne	331768	Agent - Life	3/24/2022
Active	Lago, Enrique	751233	Agent - Health	2/16/2022
Active	Lago, Enrique	751233	Agent - Life	2/16/2022
Inactive	Melhado, Michelle	882895	Agent - Health	1/18/2024	3/22/2024
Inactive	Melhado, Michelle	882895	Agent - Life	1/18/2024	3/22/2024
Inactive	Mercado, Ana Rita	602565	Agent - Health	3/11/2020	6/13/2024
Inactive	Mercado, Ana Rita	602565	Agent - Life	3/11/2020	6/13/2024
Active	Merrill, Cheryl Ann	881944	Agent - Health	3/24/2022
Active	Merrill, Cheryl Ann	881944	Agent - Life	3/24/2022
Inactive	Miano, Linda M	783014	Agent - Health	2/16/2022	6/13/2024
Inactive	Miano, Linda M	783014	Agent - Life	2/16/2022	6/13/2024
Active	Middleman, Stephen E	776362	Agent - Health	3/11/2020
Active	Middleman, Stephen E	776362	Agent - Life	3/11/2020
Active	Morano, Gregory J	309386	Agent - Casualty	3/10/2023
Active	Morano, Gregory J	309386	Agent - Health	10/28/2021
Active	Morano, Gregory J	309386	Agent - Life	10/28/2021
Active	Morano, Gregory J	309386	Agent - Property	3/10/2023
Active	Oddo, Adam Dean	1141320	Agent - Health	5/22/2023
Active	Oddo, Adam Dean	1141320	Agent - Life	5/22/2023
Active	Pantalone, Jo A	360158	Agent - Health	3/24/2022
Active	Pantalone, Jo A	360158	Agent - Life	3/24/2022
Active	Pantalone, Louis J	310251	Agent - Casualty	12/4/2009
Active	Pantalone, Louis J	310251	Agent - Health	8/16/2006
Active	Pantalone, Louis J	310251	Agent - Life	8/16/2006
Active	Pantalone, Louis J	310251	Agent - Property	12/4/2009
Inactive	Perdue, Tina Martin	802346	Agent - Health	3/11/2020	10/31/2023
Inactive	Perdue, Tina Martin	802346	Agent - Life	3/11/2020	10/31/2023
Active	Piela, Greg Scott	841564	Agent - Health	2/16/2022
Active	Piela, Greg Scott	841564	Agent - Life	2/16/2022
Active	Richman, Melissa D	751228	Agent - Health	2/25/2019
Active	Richman, Melissa D	751228	Agent - Life	2/25/2019
Active	Sacco, Craig Louis	366250	Agent - Health	3/24/2022
Active	Sacco, Craig Louis	366250	Agent - Life	3/24/2022
Active	Santiago, Maribel M	1179128	Agent - Health	8/22/2023
Active	Santiago, Maribel M	1179128	Agent - Life	8/22/2023
Active	Schwenk, Debra Robin	610443	Agent - Health	3/24/2022
Active	Schwenk, Debra Robin	610443	Agent - Life	3/24/2022
Active	Shepard, Jeanne Howard	1042498	Agent - Health	5/22/2023
Active	Shepard, Jeanne Howard	1042498	Agent - Life	5/22/2023
Active	Stewart, Laura B	1152733	Agent - Health	2/16/2022
Active	Stewart, Laura B	1152733	Agent - Life	2/16/2022
Active	Valentino, Deena Catherine	1152336	Agent - Health	9/25/2023
Active	Valentino, Deena Catherine	1152336	Agent - Life	9/25/2023
Active	Wagner, David Allen	590127	Agent - Health	3/11/2020
Active	Wagner, David Allen	590127	Agent - Life	3/11/2020
Active	Waller, Claudia	818796	Agent - Health	2/26/2021
Active	Waller, Claudia	818796	Agent - Life	2/26/2021
Active	Walton, Brenda Jane	802324	Agent - Health	3/11/2020
Active	Walton, Brenda Jane	802324	Agent - Life	3/11/2020
Inactive	Wilson, Zachary R	724658	Agent - Health	3/11/2020	7/17/2023
Inactive	Wilson, Zachary R	724658	Agent - Life	3/11/2020	7/17/2023