DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Relation Insurance Services of California, Inc.	DOIID	741250	NAIC NPN	13936509

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/29/2010		3/31/2026
Active	Non Resident	Agent	Life	10/29/2010		3/31/2026
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	10/5/2012	10/20/2018
Inactive	Anthem Life Insurance Company	301209	Agent - Health	10/5/2012	10/20/2018
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/5/2012	10/20/2018
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	1/30/2012	9/3/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/30/2012	9/3/2013
Inactive	Humana Insurance Company	301104	Agent - Health	1/30/2012	9/3/2013
Inactive	Humana Insurance Company	301104	Agent - Life	1/30/2012	9/3/2013
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/30/2012	9/3/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/30/2012	9/3/2013

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Jones Gyllstrom, Nicole	709596	Agent - Health	10/29/2010	6/17/2015
Inactive	Jones Gyllstrom, Nicole	709596	Agent - Life	10/29/2010	6/17/2015
Denied	Martin, Stephen Douglas	859805	Agent - Health
Denied	Martin, Stephen Douglas	859805	Agent - Life
Active	Varni, Keri Ann	865527	Agent - Health	4/29/2015
Active	Varni, Keri Ann	865527	Agent - Life	4/29/2015