DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ford-Dalmazzi, Melissa A	DOIID	741798	NAIC NPN	15986322

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	11/5/2010	8/1/2014
Inactive	Non Resident	Agent	Life	11/5/2010	8/1/2014
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	5/7/2011	8/1/2014
Inactive	Aetna Life Insurance Company	301140	Agent - Health	5/7/2011	8/1/2014
Inactive	Aetna Life Insurance Company	301140	Agent - Life	5/7/2011	8/1/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	3/30/2011	4/24/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/30/2011	4/24/2014
Inactive	Gerber Life Insurance Company	300529	Agent - Health	9/15/2011	12/26/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	9/15/2011	12/26/2012
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/10/2012	4/24/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/30/2011	4/24/2014
Inactive	Humana Insurance Company	301104	Agent - Health	7/20/2012	4/24/2014
Inactive	Humana Insurance Company	301104	Agent - Life	7/20/2012	4/24/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	3/30/2011	4/24/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	3/30/2011	4/24/2014
Inactive	Kanawha Insurance Company	300127	Agent - Health	3/30/2011	4/24/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	3/30/2011	4/24/2014
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	1/3/2011	12/26/2012
Inactive	Omaha Insurance Company	751908	Agent - Health	4/17/2012	6/24/2013
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	1/3/2011	12/26/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	1/3/2011	12/26/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AmWINS Group Benefits, LLC	521331	Agent - Health	1/3/2011	3/24/2014
Inactive	AmWINS Group Benefits, LLC	521331	Agent - Life	1/3/2011	3/24/2014