DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Russ, Mark A	DOIID	696936	NAIC NPN	1627253

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	1/28/2009		8/31/2026
Active	Non Resident	Agent	Casualty	1/28/2009		8/31/2026
Inactive	Non Resident	Agent	Life	1/28/2009	6/21/2018
Inactive	Non Resident	Agent	Health	1/28/2009	6/21/2018
Denied	Non Resident	Property & Casualty Consultant	Not Applicable
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	06/15/2024	08/31/2024	06/28/2024	06/28/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Church Mutual Insurance Company, S.I.	301554	Agent - Casualty	7/8/2016	11/12/2020
Inactive	Church Mutual Insurance Company, S.I.	301554	Agent - Property	7/8/2016	11/12/2020
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/29/2013	12/5/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/29/2013	12/5/2014
Inactive	GuideOne Elite Insurance Company	300490	Agent - Casualty	7/13/2016	10/31/2022
Inactive	GuideOne Elite Insurance Company	300490	Agent - Property	7/13/2016	10/31/2022
Inactive	GuideOne Insurance Company	301794	Agent - Casualty	7/13/2016	10/31/2022
Inactive	GuideOne Insurance Company	301794	Agent - Property	7/13/2016	10/31/2022
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Casualty	7/13/2016	10/31/2022
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Property	7/13/2016	10/31/2022
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/29/2013	12/5/2014
Inactive	Humana Insurance Company	301104	Agent - Health	10/29/2013	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Life	10/29/2013	12/8/2015
Inactive	Kanawha Insurance Company	300127	Agent - Health	10/29/2013	12/5/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	10/29/2013	12/5/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Assurance Agency LTD	552246	Agent - Life
Denied	Assurance Agency LTD	552246	Agent - Health
Inactive	Assurance Agency LTD	552246	Agent - Casualty	7/15/2016	3/31/2022
Inactive	Assurance Agency LTD	552246	Agent - Property	7/15/2016	3/31/2022
Inactive	Leavitt Ins Services Of Los Angeles Inc	782663	Agent - Life	5/24/2012	7/22/2015
Inactive	Leavitt Ins Services Of Los Angeles Inc	782663	Agent - Health	5/24/2012	7/22/2015
Inactive	Leavitt Ins Services Of Los Angeles Inc	782663	Agent - Casualty	5/24/2012	7/22/2015
Inactive	Leavitt Ins Services Of Los Angeles Inc	782663	Agent - Property	5/24/2012	7/22/2015
Inactive	Mcgriff Insurance Services, LLC	400877	Agent - Casualty	6/27/2019	10/31/2022
Inactive	Mcgriff Insurance Services, LLC	400877	Agent - Property	6/27/2019	10/31/2022