DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Van Gilder, Michael Clark	DOIID	748347	NAIC NPN	1606189

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	2/17/2011	3/31/2013
Inactive	Non Resident	Agent	Life	2/17/2011	3/31/2013
Inactive	Non Resident	Agent	Casualty	2/17/2011	3/31/2013
Inactive	Non Resident	Agent	Property	2/17/2011	3/31/2013
* 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	CompBenefits Dental, Inc.	591692	Agent - Health	4/4/2012	3/31/2013
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/5/2012	3/31/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/5/2012	3/31/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	4/4/2012	3/31/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	4/4/2012	3/31/2013
Inactive	Kanawha Insurance Company	300127	Agent - Health	3/5/2012	3/31/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	3/5/2012	3/31/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	USI Colorado LLC	599310	Agent - Casualty
Denied	USI Colorado LLC	599310	Agent - Health
Denied	USI Colorado LLC	599310	Agent - Life
Denied	USI Colorado LLC	599310	Agent - Property