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	Health	5/6/2009	7/31/2027
Active	Non Resident	Agent	Casualty	5/26/2006	7/31/2027
Active	Non Resident	Agent	Property	5/26/2006	7/31/2027
* 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	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
Inactive	RLI Insurance Company	301217	Agent - Casualty	6/19/2020	6/24/2025
Inactive	RLI Insurance Company	301217	Agent - Property	6/19/2020	6/24/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive 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
Inactive	General Automobile Ins Services Inc	706632	Agent - Casualty	12/27/2023	6/11/2025