DEPARTMENT OF INSURANCE

Affiliations

Name	Brotz, Simon	DOIID	774635	NAIC NPN	16524918

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Casualty	2/13/2012	6/30/2021
Inactive	Non Resident	Agent	Property	2/13/2012	6/30/2021
Inactive	Non Resident	Agent	Health	2/13/2012	6/30/2021
* 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	AMEX Assurance Company	301728	Agent - Casualty	2/22/2012	1/22/2013
Inactive	AMEX Assurance Company	301728	Agent - Health	2/22/2012	1/22/2013
Inactive	AMEX Assurance Company	301728	Agent - Property	2/22/2012	1/22/2013
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	4/5/2013	1/27/2021
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Health	4/5/2013	9/23/2015
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	4/5/2013	1/27/2021
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	5/2/2013	6/30/2021
Inactive	American Modern Home Insurance Company	300791	Agent - Property	5/2/2013	6/30/2021
Inactive	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	5/20/2019	6/30/2021
Inactive	American Modern Property and Casualty Insurance Company	301954	Agent - Property	5/20/2019	6/30/2021
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	4/12/2013	6/30/2021
Inactive	American Modern Select Insurance Company	581481	Agent - Property	4/12/2013	6/30/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	4/12/2013	6/30/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	4/12/2013	6/30/2021
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/18/2013	6/30/2021
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/18/2013	6/30/2021
Inactive	Homesite Insurance Company	301139	Agent - Casualty	10/23/2017	6/30/2021
Inactive	Homesite Insurance Company	301139	Agent - Property	10/23/2017	6/30/2021
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/23/2017	6/30/2021
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/23/2017	6/30/2021
Inactive	Midvale Indemnity Company	300292	Agent - Casualty	4/19/2019	6/30/2021
Inactive	Midvale Indemnity Company	300292	Agent - Property	4/19/2019	6/30/2021
Inactive	RLI Insurance Company	301217	Agent - Casualty	4/8/2013	6/30/2021
Inactive	RLI Insurance Company	301217	Agent - Property	4/8/2013	6/30/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	APAC Customer Services Inc	505425	Agent - Health	2/22/2012	1/18/2013
Inactive	APAC Customer Services Inc	505425	Agent - Property	2/22/2012	1/18/2013
Inactive	APAC Customer Services Inc	505425	Agent - Casualty	2/22/2012	1/18/2013
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	4/5/2013	8/10/2021
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	4/5/2013	8/10/2021