DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Provident Insurance Agency, LLC	DOIID	759825	NAIC NPN	16326374

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Property	8/24/2011	10/1/2012
Inactive	Resident	Agent	Casualty	8/24/2011	10/1/2012
* 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	Bristol West Insurance Company	301655	Agent - Casualty	12/2/2011	10/1/2012
Inactive	Bristol West Insurance Company	301655	Agent - Property	12/2/2011	10/1/2012
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	12/2/2011	10/1/2012
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	12/2/2011	10/1/2012
Inactive	National General Insurance Company	300152	Agent - Casualty	10/19/2011	10/1/2012
Inactive	National General Insurance Company	300152	Agent - Property	10/19/2011	10/1/2012
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	9/13/2011	10/1/2012
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	9/13/2011	10/1/2012
Inactive	Progressive Northern Insurance Company	301378	Agent - Casualty	9/13/2011	10/1/2012
Inactive	Progressive Northern Insurance Company	301378	Agent - Property	9/13/2011	10/1/2012
Inactive	United Financial Casualty Company	301886	Agent - Casualty	9/13/2011	10/1/2012
Inactive	United Financial Casualty Company	301886	Agent - Property	9/13/2011	10/1/2012

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Adams, Tom K	351115	Agent - Casualty	8/24/2011	8/1/2012
Inactive	Adams, Tom K	351115	Agent - Property	8/24/2011	8/1/2012