DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Stallworth, Harold Jermain	DOIID	781131	NAIC NPN	16630030

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	5/5/2012	9/30/2019
Inactive	Non Resident	Agent	Property	5/5/2012	9/30/2019
* 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	American Modern Select Insurance Company	581481	Agent - Casualty	9/2/2016	9/30/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Property	9/2/2016	9/30/2019
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	9/19/2015	3/28/2018
Inactive	Bristol West Insurance Company	301655	Agent - Property	9/19/2015	3/28/2018
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	2/18/2014	3/26/2018
Inactive	Dairyland Insurance Company	301370	Agent - Property	2/18/2014	3/26/2018
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	11/5/2012	3/28/2018
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	11/5/2012	3/28/2018
Inactive	National General Insurance Company	300152	Agent - Casualty	5/10/2012	3/13/2018
Inactive	National General Insurance Company	300152	Agent - Property	5/10/2012	3/13/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	4/4/2013	3/29/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	4/4/2013	3/29/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/4/2013	3/29/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/4/2013	3/29/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Affinity Brokerage, LLC	544886	Agent - Property	10/24/2012	3/14/2018
Inactive	Affinity Brokerage, LLC	544886	Agent - Casualty	10/24/2012	3/14/2018
Inactive	CWI, LLC	662170	Agent - Property	6/12/2012	3/14/2018
Inactive	CWI, LLC	662170	Agent - Casualty	6/12/2012	3/14/2018
Inactive	Camping World Insurance Services of Kentucky, LLC	663187	Agent - Property	5/13/2013	3/14/2018
Inactive	Camping World Insurance Services of Kentucky, LLC	663187	Agent - Casualty	5/13/2013	3/14/2018
Inactive	National General Ins Marketing Inc	621228	Agent - Property	6/11/2012	3/14/2018
Inactive	National General Ins Marketing Inc	621228	Agent - Casualty	6/11/2012	3/14/2018