DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fox, Jack Richard	DOIID	689049	NAIC NPN	648936

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	9/11/2008	7/31/2012
Inactive	Non Resident	Agent	Property	9/11/2008	7/31/2012
* 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	MAG Mutual Insurance Company	500011	Agent - Casualty	9/18/2008	6/28/2012
Inactive	MAG Mutual Insurance Company	500011	Agent - Property	9/18/2008	6/28/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Magmutual Placement Services, LLC	735275	Agent - Casualty	10/1/2010	7/31/2012
Inactive	Magmutual Placement Services, LLC	735275	Agent - Property	10/1/2010	7/31/2012