DEPARTMENT OF INSURANCE

Affiliations

Name	Gray, Haley Dawn	DOIID	756224	NAIC NPN	16259739

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Denied	Resident	Agent	Health
Inactive	Non Resident	Agent	Property	5/22/2012	9/16/2016
Inactive	Non Resident	Agent	Casualty	5/22/2012	9/16/2016
Inactive	Resident	Agent	Life	6/20/2011	12/1/2011
Inactive	Resident	Agent	Variable Life and Variable Annuities	8/4/2011	11/30/2011
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	1st Choice Advantage Insurance Company, Inc.	750782	Agent - Casualty	4/1/2013	9/16/2016
Inactive	American Family Home Insurance Company	301817	Agent - Casualty	1/28/2015	9/16/2016
Inactive	American Family Home Insurance Company	301817	Agent - Property	1/28/2015	9/16/2016
Inactive	American Fire and Casualty Company	300567	Agent - Casualty	4/1/2013	5/21/2015
Inactive	American Fire and Casualty Company	300567	Agent - Property	4/1/2013	5/21/2015
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	1/28/2015	9/16/2016
Inactive	American Modern Home Insurance Company	300791	Agent - Property	1/28/2015	9/16/2016
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	1/28/2015	9/16/2016
Inactive	American Modern Select Insurance Company	581481	Agent - Property	1/28/2015	9/16/2016
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	1/28/2015	9/16/2016
Inactive	American Southern Home Insurance Company	626276	Agent - Property	1/28/2015	9/16/2016
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	4/1/2013	9/16/2016
Inactive	Bristol West Insurance Company	301655	Agent - Property	4/1/2013	9/16/2016
Inactive	Cincinnati Casualty Company (The)	300308	Agent - Casualty	3/14/2013	11/24/2015
Inactive	Cincinnati Casualty Company (The)	300308	Agent - Property	3/14/2013	11/24/2015
Inactive	Cincinnati Indemnity Company (The)	301566	Agent - Casualty	3/14/2013	11/24/2015
Inactive	Cincinnati Indemnity Company (The)	301566	Agent - Property	3/14/2013	11/24/2015
Inactive	Cincinnati Insurance Company	301298	Agent - Casualty	3/14/2013	11/24/2015
Inactive	Cincinnati Insurance Company	301298	Agent - Property	3/14/2013	11/24/2015
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Consolidated Insurance Company	300943	Agent - Property	4/1/2013	5/21/2015
Inactive	Everett Cash Mutual Insurance Company	750768	Agent - Casualty	4/1/2013	9/16/2016
Inactive	Everett Cash Mutual Insurance Company	750768	Agent - Property	4/1/2013	9/16/2016
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/1/2013	9/16/2016
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/1/2013	9/16/2016
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	4/1/2013	9/16/2016
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	4/1/2013	9/16/2016
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	4/1/2013	9/16/2016
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	4/1/2013	9/16/2016
Denied	Foresters Life Insurance and Annuity Company	300882	Agent - Health
Inactive	Foresters Life Insurance and Annuity Company	300882	Agent - Life	6/20/2011	11/30/2011
Inactive	Foresters Life Insurance and Annuity Company	300882	Agent - Variable Life and Variable Annuities	8/4/2011	11/30/2011
Inactive	Independent Order of Foresters	300743	Agent - Life	9/7/2011	11/30/2011
Inactive	Indiana Insurance Company	301909	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Indiana Insurance Company	301909	Agent - Property	4/1/2013	5/21/2015
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	4/1/2013	5/21/2015
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	4/1/2013	5/21/2015
Inactive	Ohio Security Insurance Company	300622	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Ohio Security Insurance Company	300622	Agent - Property	4/1/2013	5/21/2015
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Property	4/1/2013	5/21/2015
Inactive	Peerless Insurance Company	301910	Agent - Casualty	4/1/2013	5/21/2015
Inactive	Peerless Insurance Company	301910	Agent - Property	4/1/2013	5/21/2015
Inactive	Philadelphia Indemnity Insurance Company	301221	Agent - Casualty	4/24/2013	9/16/2016
Inactive	Philadelphia Indemnity Insurance Company	301221	Agent - Property	4/24/2013	9/16/2016
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	4/1/2013	5/21/2015
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	4/1/2013	5/21/2015
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/1/2013	5/21/2015
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/1/2013	5/21/2015
Inactive	West American Insurance Company	301112	Agent - Casualty	4/1/2013	5/21/2015
Inactive	West American Insurance Company	301112	Agent - Property	4/1/2013	5/21/2015
Inactive	Westfield Insurance Company	301950	Agent - Casualty	3/28/2013	9/16/2016
Inactive	Westfield Insurance Company	301950	Agent - Property	3/28/2013	9/16/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ferrell and Evans, LLC	398891	Agent - Casualty	3/14/2013	4/29/2015
Inactive	Ferrell and Evans, LLC	398891	Agent - Property	3/14/2013	4/29/2015