DEPARTMENT OF INSURANCE

Affiliations

Name	Wiatr, David Michael	DOIID	766744	NAIC NPN	15659686

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	8/23/2013	4/30/2025
Active	Non Resident	Agent	Health	8/23/2013	4/30/2025
Active	Non Resident	Agent	Life	8/23/2013	4/30/2025
Active	Non Resident	Agent	Property	8/23/2013	4/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	02/15/2025	04/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	2/2/2012	4/30/2013
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/2/2012	4/30/2013
Active	Allmerica Financial Alliance Insurance Company	300823	Agent - Casualty	10/1/2018
Active	Allmerica Financial Alliance Insurance Company	300823	Agent - Property	10/1/2018
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Casualty	10/1/2018
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Property	10/1/2018
Inactive	AmGUARD Insurance Company	500010	Agent - Casualty	11/11/2019	9/2/2024
Inactive	AmGUARD Insurance Company	500010	Agent - Property	11/11/2019	9/2/2024
Active	American Builders Insurance Company	677578	Agent - Casualty	8/5/2021
Active	American Builders Insurance Company	677578	Agent - Property	8/5/2021
Active	American Contractors Indemnity Company	536843	Agent - Casualty	2/5/2019
Active	American Economy Insurance Company	300315	Agent - Casualty	3/31/2023
Active	American Economy Insurance Company	300315	Agent - Property	3/31/2023
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	3/13/2018	8/15/2018
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	3/13/2018	8/15/2018
Inactive	Anthem Life Insurance Company	301209	Agent - Health	3/2/2012	4/30/2013
Inactive	Anthem Life Insurance Company	301209	Agent - Life	3/2/2012	4/30/2013
Inactive	Auto-Owners Insurance Company	301480	Agent - Casualty	9/9/2014	9/4/2018
Inactive	Auto-Owners Insurance Company	301480	Agent - Property	9/9/2014	9/4/2018
Inactive	Banner Life Insurance Company	301696	Agent - Life	7/12/2012	4/30/2013
Active	Benchmark Insurance Company	300374	Agent - Casualty	7/1/2019
Active	Benchmark Insurance Company	300374	Agent - Property	7/1/2019
Active	BrickStreet Mutual Insurance Company	709251	Agent - Casualty	9/30/2020
Active	Bristol West Insurance Company	301655	Agent - Casualty	11/22/2019
Active	Bristol West Insurance Company	301655	Agent - Property	11/22/2019
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	6/16/2015	12/8/2015
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/16/2015	12/8/2015
Inactive	Encova Life Insurance Company	301818	Agent - Life	12/8/2021	1/1/2024
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Casualty	1/8/2021	12/29/2021
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Property	1/8/2021	12/29/2021
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	1/8/2021	4/26/2022
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	1/8/2021	4/26/2022
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	11/22/2019
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	11/22/2019
Inactive	Golden Rule Insurance Company	301943	Agent - Health	9/3/2013	8/30/2019
Inactive	Golden Rule Insurance Company	301943	Agent - Life	9/3/2013	8/30/2019
Active	Grange Indemnity Insurance Company	300793	Agent - Casualty	10/4/2019
Active	Grange Indemnity Insurance Company	300793	Agent - Property	10/4/2019
Active	Grange Insurance Company	300234	Agent - Casualty	10/4/2019
Active	Grange Insurance Company	300234	Agent - Property	10/4/2019
Inactive	Grange Life Insurance Company	300128	Agent - Health	1/26/2014	9/11/2018
Inactive	Grange Life Insurance Company	300128	Agent - Life	1/26/2014	9/11/2018
Active	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	10/4/2019
Active	Grange Property & Casualty Insurance Company	601680	Agent - Property	10/4/2019
Active	Hanover American Insurance Company (The)	300447	Agent - Casualty	10/1/2018
Active	Hanover American Insurance Company (The)	300447	Agent - Property	10/1/2018
Active	Hanover Insurance Company (The)	300508	Agent - Casualty	10/1/2018
Active	Hanover Insurance Company (The)	300508	Agent - Property	10/1/2018
Inactive	Hartford Insurance Company of the Southeast	1014204	Agent - Casualty	4/28/2021	7/24/2023
Inactive	Hartford Insurance Company of the Southeast	1014204	Agent - Property	4/28/2021	7/24/2023
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	10/31/2021	7/24/2023
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	10/31/2021	7/24/2023
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	5/14/2014	5/4/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/16/2015	5/2/2016
Inactive	Humana Insurance Company	301104	Agent - Health	6/16/2015	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Life	9/4/2013	5/4/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/4/2013	5/4/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	5/14/2014	5/4/2015
Inactive	HumanaDental Insurance Company	301457	Agent - Health	3/19/2012	12/19/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	3/19/2012	12/19/2012
Active	Insurance Company of the West	301520	Agent - Casualty	11/16/2018
Active	Insurance Company of the West	301520	Agent - Property	11/16/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	6/16/2015	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	6/16/2015	10/22/2015
Active	MICO Insurance Company	301664	Agent - Casualty	10/28/2021
Active	MICO Insurance Company	301664	Agent - Property	10/28/2021
Active	Massachusetts Bay Insurance Company	300898	Agent - Casualty	10/1/2018
Active	Massachusetts Bay Insurance Company	300898	Agent - Property	10/1/2018
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Casualty	1/22/2020
Active	Motorists Commercial Mutual Insurance Company	301941	Agent - Property	1/22/2020
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	3/26/2020	2/20/2022
Active	National Builders Insurance Company	677579	Agent - Casualty	8/5/2021
Active	National Builders Insurance Company	677579	Agent - Property	8/5/2021
Inactive	NorGUARD Insurance Company	500015	Agent - Casualty	11/11/2019	9/2/2024
Active	NorthStone Insurance Company	818905	Agent - Casualty	9/30/2020
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	2/4/2022
Active	Ohio Casualty Insurance Company	301492	Agent - Property	2/4/2022
Active	Old Republic Insurance Company	301225	Agent - Casualty	6/28/2023
Inactive	Owners Insurance Company	300796	Agent - Casualty	9/9/2014	9/4/2018
Inactive	Owners Insurance Company	300796	Agent - Property	9/9/2014	9/4/2018
Active	Pan-American Life Insurance Company	301530	Agent - Life	1/1/2024
Active	PinnaclePoint Insurance Company	819085	Agent - Casualty	9/30/2020
Active	Plaza Insurance Company	300748	Agent - Casualty	3/4/2022
Active	Plaza Insurance Company	300748	Agent - Property	3/4/2022
Active	Property and Casualty Insurance Company of Hartford	301409	Agent - Casualty	7/3/2024
Active	Property and Casualty Insurance Company of Hartford	301409	Agent - Property	7/3/2024
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	1/11/2016
Active	SAFECO Insurance Company of America	300159	Agent - Property	1/11/2016
Active	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	3/31/2023
Active	SAFECO Insurance Company of Illinois	301350	Agent - Property	3/31/2023
Inactive	Selective Insurance Company of America	500018	Agent - Casualty	3/12/2014	9/4/2018
Inactive	Selective Insurance Company of America	500018	Agent - Property	3/12/2014	9/4/2018
Inactive	Selective Insurance Company of South Carolina	500012	Agent - Casualty	3/12/2014	9/4/2018
Inactive	Selective Insurance Company of South Carolina	500012	Agent - Property	3/12/2014	9/4/2018
Inactive	Selective Insurance Company of the Southeast	300381	Agent - Casualty	3/12/2014	9/4/2018
Inactive	Selective Insurance Company of the Southeast	300381	Agent - Property	3/12/2014	9/4/2018
Active	Sentinel Insurance Company, Limited	501696	Agent - Casualty	1/11/2023
Active	Sentinel Insurance Company, Limited	501696	Agent - Property	1/11/2023
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	6/16/2021
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	6/16/2021
Active	SummitPoint Insurance Company	819084	Agent - Casualty	9/30/2020
Active	Trumbull Insurance Company	300242	Agent - Casualty	2/20/2024
Active	Trumbull Insurance Company	300242	Agent - Property	2/20/2024
Active	Trustgard Insurance Company	300104	Agent - Casualty	10/4/2019
Active	Trustgard Insurance Company	300104	Agent - Property	10/4/2019
Active	U.S. Specialty Insurance Company	300186	Agent - Casualty	2/5/2019
Active	U.S. Specialty Insurance Company	300186	Agent - Property	2/5/2019
Inactive	United World Life Insurance Company	300532	Agent - Health	3/26/2020	2/20/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/26/2020	2/20/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/26/2020	2/20/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/17/2018	7/1/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	10/17/2018	7/1/2019
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Health	11/12/2015	11/4/2016
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Life	11/12/2015	11/4/2016
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	10/17/2018	7/1/2019
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/17/2018	7/1/2019
Active	Verlan Fire Insurance Company	517102	Agent - Casualty	10/1/2018
Active	Verlan Fire Insurance Company	517102	Agent - Property	10/1/2018
Active	Westfield Insurance Company	301950	Agent - Casualty	9/24/2020
Active	Westfield Insurance Company	301950	Agent - Property	9/24/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bna Insurance Group, LLC	1010381	Agent - Health	9/19/2018
Active	Bna Insurance Group, LLC	1010381	Agent - Life	9/19/2018
Active	Bna Insurance Group, LLC	1010381	Agent - Casualty	9/19/2018
Active	Bna Insurance Group, LLC	1010381	Agent - Property	9/19/2018
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/13/2013	11/2/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	9/4/2013	11/2/2016
Active	Ins Professionals Of Tennessee LLC	773829	Agent - Casualty	9/9/2014
Active	Ins Professionals Of Tennessee LLC	773829	Agent - Property	9/9/2014
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	11/4/2011	3/27/2012