DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Rose, Adam D	DOIID	661015	NAIC NPN	9337366

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	9/4/2007	9/8/2011
Inactive	Non Resident	Agent	Health	1/26/2010	9/8/2011
Inactive	Non Resident	Agent	Property	9/4/2007	9/8/2011
* 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	2/3/2010	7/12/2010
Inactive	AMEX Assurance Company	301728	Agent - Health	3/22/2010	7/12/2010
Inactive	AMEX Assurance Company	301728	Agent - Property	2/3/2010	7/12/2010
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	9/27/2007	9/16/2009
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	9/27/2007	9/16/2009
Inactive	RLI Insurance Company	301217	Agent - Casualty	7/11/2008	9/16/2009
Inactive	RLI Insurance Company	301217	Agent - Property	7/11/2008	9/16/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	APAC Customer Services Inc	505425	Agent - Casualty	2/3/2010	7/8/2010
Inactive	APAC Customer Services Inc	505425	Agent - Property	2/3/2010	7/8/2010
Inactive	APAC Customer Services Inc	505425	Agent - Health	6/3/2010	7/8/2010
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	8/4/2008	9/16/2009
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	8/4/2008	9/16/2009