DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Charles E	DOIID	706023	NAIC NPN	2772328

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	5/18/2009		10/31/2024
Active	Non Resident	Agent	Health	5/18/2009		10/31/2024
Active	Non Resident	Agent	Casualty	5/18/2009		10/31/2024
Active	Non Resident	Agent	Life	5/18/2009		10/31/2024
* 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	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	12/22/2009	10/5/2021
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	12/22/2009	10/5/2021
Active	Continental Casualty Company	301019	Agent - Casualty	4/26/2012
Active	Continental Casualty Company	301019	Agent - Property	4/26/2012
Active	Doctors Company, an Interinsurance Exchange (The)	301946	Agent - Casualty	10/21/2021
Active	Doctors Company, an Interinsurance Exchange (The)	301946	Agent - Property	10/21/2021
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	12/22/2009	7/11/2024
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	12/22/2009	7/11/2024
Active	Medical Protective Company (The)	301207	Agent - Casualty	7/1/2021
Active	Medical Protective Company (The)	301207	Agent - Property	7/1/2021
Inactive	ProAssurance Casualty Company	300928	Agent - Casualty	3/28/2011	12/31/2023
Active	ProAssurance Indemnity Company, Inc.	301859	Agent - Casualty	12/13/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Property	4/26/2012	8/24/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Life	12/22/2009	8/24/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Casualty	4/26/2012	8/24/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Health	12/22/2009	8/24/2020