DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Erickson, Lisa Ann	DOIID	712529	NAIC NPN	2603060

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	8/31/2009	11/30/2015
Inactive	Non Resident	Agent	Property	8/31/2009	11/30/2015
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	9/16/2009	11/30/2015
* 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	AmTrust Insurance Company	300179	Agent - Casualty	9/25/2012	3/17/2014
Inactive	AmTrust Insurance Company	300179	Agent - Property	9/25/2012	3/17/2014
Inactive	Milford Casualty Insurance Company	301460	Agent - Casualty	9/25/2012	3/17/2014
Inactive	Milford Casualty Insurance Company	301460	Agent - Property	9/25/2012	3/17/2014
Inactive	Park National Insurance Company	692514	Agent - Casualty	10/10/2013	3/17/2014
Inactive	Park National Insurance Company	692514	Agent - Property	10/10/2013	3/17/2014
Inactive	Security National Insurance Company	301151	Agent - Casualty	9/25/2012	3/17/2014
Inactive	Security National Insurance Company	301151	Agent - Property	9/25/2012	3/17/2014
Inactive	Sequoia Insurance Company	628046	Agent - Casualty	10/10/2013	3/17/2014
Inactive	Sequoia Insurance Company	628046	Agent - Property	10/10/2013	3/17/2014
Inactive	Technology Insurance Company	613278	Agent - Casualty	9/25/2012	3/17/2014
Inactive	Technology Insurance Company	613278	Agent - Property	9/25/2012	3/17/2014
Inactive	Wesco Insurance Company	300534	Agent - Casualty	9/25/2012	3/17/2014
Inactive	Wesco Insurance Company	300534	Agent - Property	9/25/2012	3/17/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Builders & TradesmenNULLs Insurance Services, Inc.	713412	Agent - Property	9/15/2009	3/17/2014
Inactive	Builders & TradesmenNULLs Insurance Services, Inc.	713412	Agent - Casualty	9/15/2009	3/17/2014
Inactive	Builders & TradesmenNULLs Insurance Services, Inc.	713412	Surplus Lines Broker - Not Applicable	12/1/2009	9/5/2014