DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Park, Lisa M	DOIID	754554	NAIC NPN	16232821

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Denied	Resident	Agent	Property
Inactive	Resident	Agent	Casualty	4/26/2012	3/1/2017
* 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	Merchants Bonding Company (Mutual)	300170	Agent - Casualty	7/28/2014	3/1/2017
Inactive	Merchants National Bonding Inc.	787525	Agent - Casualty	7/28/2014	3/1/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Public Entity Insurance, Inc.	398396	Agent - Casualty	7/28/2014	8/9/2016