DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mulchek, Donna J	DOIID	743700	NAIC NPN	5052630

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	12/3/2010	4/30/2016
Inactive	Non Resident	Agent	Property	12/3/2010	4/30/2016
* 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	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	3/9/2011	10/14/2014
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	3/9/2011	10/14/2014
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	5/2/2014	1/5/2015
Inactive	Bristol West Insurance Company	301655	Agent - Property	5/2/2014	1/5/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	5/2/2014	1/5/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	5/2/2014	1/5/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Property	4/15/2011	9/30/2014
Inactive	USI Insurance Services National, Inc	509421	Agent - Casualty	4/15/2011	9/30/2014