DEPARTMENT OF INSURANCE

Affiliations

Name	Self Funded Services Company	DOIID	654476	NAIC NPN	3197992

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	6/13/2007	7/1/2010
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ottavi, John J	558911	Administrator - Not Applicable	6/13/2007	7/1/2010