DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Frick, Connie	DOIID	654270	NAIC NPN	4903086

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	5/1/2007	10/31/2009
Inactive	Non Resident	Agent	Health	5/1/2007	10/31/2009
* 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	Provident Life and Accident Insurance Company	301525	Agent - Health	10/30/2007	12/30/2009
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	10/30/2007	12/30/2009
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	10/30/2007	12/30/2009
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	10/30/2007	12/30/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Mercer Health & Benefits LLC	607080	Agent - Health	11/12/2007	10/31/2009
Inactive	Mercer Health & Benefits LLC	607080	Agent - Life	11/12/2007	10/31/2009