DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Green, David	DOIID	726315	NAIC NPN	3096364

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	4/12/2010		8/31/2024
Active	Non Resident	Agent	Life	12/14/2011		8/31/2024
Active	Non Resident	Agent	Casualty	4/12/2010		8/31/2024
* 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	06/15/2024	08/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Casualty	3/31/2017	8/25/2022
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Property	3/31/2017	8/25/2022
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	3/31/2017	8/25/2022
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	3/31/2017	8/25/2022
Inactive	Independence American Insurance Company	524747	Agent - Casualty	7/30/2020	12/18/2020
Inactive	Independence American Insurance Company	524747	Agent - Property	7/30/2020	12/30/2022
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	1/9/2012	12/15/2016
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	1/9/2012	12/15/2016
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Casualty	4/21/2010	11/15/2016
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Property	4/21/2010	11/15/2016
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	5/26/2010	12/5/2016
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	5/26/2010	12/5/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fx Insurance Agency, LLC	646184	Agent - Property	6/3/2021	8/30/2022
Inactive	Fx Insurance Agency, LLC	646184	Agent - Casualty	6/3/2021	8/25/2022
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Property	11/2/2022	12/30/2022
Denied	Nationwide Sales Solutions Inc	631821	Agent - Casualty
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Life	2/28/2012	1/10/2017