DEPARTMENT OF INSURANCE

Affiliations

Name	Costello, Samuel	DOIID	789954	NAIC NPN	16765614

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Pending Replacement	Non Resident	Agent	Casualty	8/29/2012	5/31/2024
Pending Replacement	Non Resident	Agent	Property	8/29/2012	5/31/2024
Pending Replacement	Non Resident	Agent	Health	8/29/2012	5/31/2024
* 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	9/4/2012	1/22/2013
Inactive	AMEX Assurance Company	301728	Agent - Health	9/4/2012	1/22/2013
Inactive	AMEX Assurance Company	301728	Agent - Property	9/4/2012	1/22/2013
Pending Replacement	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	4/4/2013
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Health	4/4/2013	9/24/2015
Pending Replacement	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	4/4/2013
Pending Replacement	American Modern Home Insurance Company	300791	Agent - Casualty	4/19/2013
Pending Replacement	American Modern Home Insurance Company	300791	Agent - Property	4/19/2013
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	4/12/2013	11/14/2021
Inactive	American Modern Select Insurance Company	581481	Agent - Property	4/12/2013	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	4/12/2013	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	4/12/2013	11/14/2021
Pending Replacement	Bristol West Insurance Company	301655	Agent - Casualty	5/18/2022
Pending Replacement	Bristol West Insurance Company	301655	Agent - Property	5/18/2022
Pending Replacement	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/16/2013
Pending Replacement	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/16/2013
Pending Replacement	Homesite Insurance Company	301139	Agent - Casualty	10/23/2017
Pending Replacement	Homesite Insurance Company	301139	Agent - Property	10/23/2017
Pending Replacement	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/23/2017
Pending Replacement	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/23/2017
Pending Replacement	Midvale Indemnity Company	300292	Agent - Casualty	4/19/2019
Pending Replacement	Midvale Indemnity Company	300292	Agent - Property	4/19/2019
Pending Replacement	RLI Insurance Company	301217	Agent - Casualty	4/8/2013
Pending Replacement	RLI Insurance Company	301217	Agent - Property	4/8/2013

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	10/4/2012	1/18/2013
Inactive	APAC Customer Services Inc	505425	Agent - Property	10/4/2012	1/18/2013
Inactive	APAC Customer Services Inc	505425	Agent - Casualty	10/4/2012	1/18/2013
Pending Replacement	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	4/5/2013
Pending Replacement	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	4/5/2013