DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Illa, Keith M	DOIID	746494	NAIC NPN	243818

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	1/20/2011	1/10/2018
Inactive	Non Resident	Agent	Property	1/20/2011	1/10/2018
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	2/3/2011	1/10/2018
* 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	Atlantic Specialty Insurance Company	518595	Agent - Casualty	6/12/2015	10/6/2017
Inactive	Atlantic Specialty Insurance Company	518595	Agent - Property	6/12/2015	10/6/2017
Inactive	Farmland Mutual Insurance Company	301468	Agent - Casualty	12/21/2011	1/10/2018
Inactive	Farmland Mutual Insurance Company	301468	Agent - Property	12/21/2011	1/10/2018
Inactive	Guarantee Company of North America USA (The)	300857	Agent - Casualty	3/15/2016	1/10/2018
Inactive	Nationwide Agribusiness Insurance Company	301008	Agent - Casualty	12/21/2011	1/10/2018
Inactive	Nationwide Agribusiness Insurance Company	301008	Agent - Property	12/21/2011	1/10/2018
Inactive	Westchester Fire Insurance Company	300990	Agent - Casualty	5/22/2013	1/10/2018
Inactive	Westchester Fire Insurance Company	300990	Agent - Property	5/22/2013	1/10/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CHS Insurance Services, LLC	570439	Agent - Property	12/21/2011	1/3/2018
Inactive	CHS Insurance Services, LLC	570439	Agent - Casualty	12/21/2011	1/3/2018
Inactive	CHS Insurance Services, LLC	570439	Surplus Lines Broker - Not Applicable	12/9/2011	1/3/2018