DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Godzich, Timothy Michael	DOIID	709285	NAIC NPN	2317918

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	7/14/2009	5/31/2012
Inactive	Non Resident	Agent	Health	7/14/2009	5/31/2012
* 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	Humana Health Plan, Inc.	300142	Agent - Health	5/20/2011	5/31/2012
Inactive	Humana Insurance Company	301104	Agent - Health	5/20/2011	5/31/2012
Inactive	Humana Insurance Company	301104	Agent - Life	5/20/2011	5/31/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	5/20/2011	5/31/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	5/20/2011	5/31/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Liazon Benefits Inc	710278	Agent - Health	7/29/2009	5/31/2012
Inactive	Liazon Benefits Inc	710278	Agent - Life	7/29/2009	5/31/2012