DEPARTMENT OF INSURANCE

Affiliations

Name	Rozmiarek, Debra Ann	DOIID	632797	NAIC NPN	6518076

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	5/26/2006	7/31/2025
Active	Non Resident	Agent	Health	5/6/2009	7/31/2025
Active	Non Resident	Agent	Property	5/26/2006	7/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	05/15/2025	07/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AMEX Assurance Company	301728	Agent - Casualty	6/5/2006	5/23/2007
Inactive	AMEX Assurance Company	301728	Agent - Property	6/5/2006	5/23/2007
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	7/26/2006
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Health	5/13/2009	9/25/2015
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	7/26/2006
Active	American Modern Home Insurance Company	300791	Agent - Casualty	11/10/2010
Active	American Modern Home Insurance Company	300791	Agent - Property	11/10/2010
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	7/14/2023
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Property	7/14/2023
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	7/13/2015	11/14/2021
Inactive	American Modern Select Insurance Company	581481	Agent - Property	7/13/2015	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	11/10/2010	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	11/10/2010	11/14/2021
Active	Bristol West Insurance Company	301655	Agent - Casualty	5/18/2022
Active	Bristol West Insurance Company	301655	Agent - Property	5/18/2022
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	9/13/2012
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	9/13/2012
Active	Homesite Insurance Company	301139	Agent - Casualty	10/24/2017
Active	Homesite Insurance Company	301139	Agent - Property	10/24/2017
Active	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/24/2017
Active	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/24/2017
Active	Midvale Indemnity Company	300292	Agent - Casualty	4/19/2019
Active	Midvale Indemnity Company	300292	Agent - Property	4/19/2019
Inactive	Permanent General Assurance Corporation of Ohio	709250	Agent - Casualty	12/21/2023	2/17/2025
Active	RLI Insurance Company	301217	Agent - Casualty	6/19/2020
Active	RLI Insurance Company	301217	Agent - Property	6/19/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	8/21/2006
Active	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	8/21/2006
Active	General Automobile Ins Services Inc	706632	Agent - Casualty	12/27/2023