DEPARTMENT OF INSURANCE

Affiliations

Name	Self Insurance Services, LLC	DOIID	792398	NAIC NPN	8527294

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	10/9/2020	3/31/2026
Active	Non Resident	Agent	Property	2/21/2014	3/31/2026
Active	Non Resident	Agent	Health	10/9/2020	3/31/2026
Active	Non Resident	Agent	Casualty	2/21/2014	3/31/2026
* 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
Active	AMCO Insurance Company	300204	Agent - Casualty	8/18/2017
Active	AMCO Insurance Company	300204	Agent - Property	8/18/2017
Inactive	All Savers Insurance Company	301940	Agent - Health	7/24/2013	7/25/2013
Inactive	All Savers Insurance Company	301940	Agent - Life	7/24/2013	7/25/2013
Active	Allied Insurance Company of America	793586	Agent - Casualty	8/18/2017
Active	Allied Insurance Company of America	793586	Agent - Property	8/18/2017
Active	Allied Property and Casualty Insurance Company	300279	Agent - Casualty	8/18/2017
Active	Allied Property and Casualty Insurance Company	300279	Agent - Property	8/18/2017
Inactive	American Economy Insurance Company	300315	Agent - Casualty	11/9/2019	3/29/2024
Inactive	American Economy Insurance Company	300315	Agent - Property	11/9/2019	3/29/2024
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	10/7/2019
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Property	10/7/2019
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	3/3/2016	11/30/2017
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	3/3/2016	11/30/2017
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	10/31/2021	12/20/2024
Inactive	Bristol West Insurance Company	301655	Agent - Property	10/31/2021	12/20/2024
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	9/26/2019	12/15/2020
Active	Depositors Insurance Company	301634	Agent - Casualty	8/18/2017
Active	Depositors Insurance Company	301634	Agent - Property	8/18/2017
Inactive	Encompass Indemnity Company	546376	Agent - Casualty	3/23/2021	10/3/2024
Inactive	Encompass Indemnity Company	546376	Agent - Property	3/23/2021	10/3/2024
Active	Erie Family Life Insurance Company	301400	Agent - Health	9/15/2023
Active	Erie Family Life Insurance Company	301400	Agent - Life	9/15/2023
Active	Erie Insurance Company	300230	Agent - Casualty	9/15/2023
Active	Erie Insurance Company	300230	Agent - Property	9/15/2023
Active	Erie Insurance Company of New York	789916	Agent - Casualty	2/23/2018
Active	Erie Insurance Company of New York	789916	Agent - Property	2/23/2018
Active	Erie Insurance Exchange	300789	Agent - Casualty	2/23/2018
Active	Erie Insurance Exchange	300789	Agent - Property	2/23/2018
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	9/12/2018	4/26/2024
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	9/12/2018	4/26/2024
Inactive	Farmington Casualty Company	301137	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Farmington Casualty Company	301137	Agent - Property	9/26/2019	12/15/2020
Active	Flagship City Insurance Company	789965	Agent - Casualty	2/23/2018
Active	Flagship City Insurance Company	789965	Agent - Property	2/23/2018
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	2/25/2014
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	2/25/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	9/21/2017	5/3/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	9/21/2017	5/3/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	9/21/2017	5/3/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	9/21/2017	5/3/2018
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	2/12/2020	12/10/2020
Inactive	Grange Insurance Company	300234	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Grange Insurance Company	300234	Agent - Property	2/12/2020	12/10/2020
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Property	2/12/2020	12/10/2020
Inactive	John Alden Life Insurance Company	300573	Agent - Health	10/2/2012	3/20/2013
Inactive	John Alden Life Insurance Company	300573	Agent - Life	10/2/2012	3/20/2013
Inactive	Meridian Security Insurance Company	300423	Agent - Casualty	9/28/2018	2/12/2025
Inactive	Meridian Security Insurance Company	300423	Agent - Property	9/28/2018	2/12/2025
Active	Milbank Insurance Company	925185	Agent - Casualty	9/28/2018
Active	Milbank Insurance Company	925185	Agent - Property	9/28/2018
Active	Nationwide Agribusiness Insurance Company	301008	Agent - Casualty	8/18/2017
Active	Nationwide Agribusiness Insurance Company	301008	Agent - Property	8/18/2017
Active	Nationwide Assurance Company	300166	Agent - Casualty	3/4/2020
Active	Nationwide General Insurance Company	300603	Agent - Casualty	8/28/2019
Active	Nationwide General Insurance Company	300603	Agent - Property	8/28/2019
Active	Nationwide Insurance Company of America	300333	Agent - Casualty	8/28/2019
Active	Nationwide Insurance Company of America	300333	Agent - Property	8/28/2019
Active	Nationwide Mutual Insurance Company	301749	Agent - Casualty	8/18/2017
Active	Nationwide Mutual Insurance Company	301749	Agent - Property	8/18/2017
Active	Nationwide Property and Casualty Insurance Company	300599	Agent - Casualty	2/2/2022
Active	Nationwide Property and Casualty Insurance Company	300599	Agent - Property	2/2/2022
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	10/13/2020	3/29/2024
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	10/13/2020	3/29/2024
Active	Progressive Casualty Insurance Company	300696	Agent - Casualty	4/29/2014
Active	Progressive Casualty Insurance Company	300696	Agent - Property	4/29/2014
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	6/26/2024
Active	SAFECO Insurance Company of America	300159	Agent - Property	6/26/2024
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/2/2018	3/29/2024
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/2/2018	3/29/2024
Active	Selective Insurance Company of the Southeast	300381	Agent - Casualty	3/29/2018
Active	Selective Insurance Company of the Southeast	300381	Agent - Property	3/29/2018
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Casualty	8/10/2023	11/26/2024
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Property	8/10/2023	11/26/2024
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	3/3/2016	11/26/2024
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	3/3/2016	11/26/2024
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	6/11/2014	2/1/2016
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	6/11/2014	2/1/2016
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - Casualty	9/28/2018	2/12/2025
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - Property	9/28/2018	2/12/2025
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	9/28/2018	2/12/2025
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	9/28/2018	2/12/2025
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	9/25/2018	11/26/2024
Inactive	The Phoenix Insurance Company	301502	Agent - Property	9/25/2018	11/26/2024
Inactive	Time Insurance Company	300683	Agent - Health	9/26/2012	12/20/2014
Inactive	Time Insurance Company	300683	Agent - Life	9/26/2012	12/20/2014
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company of America	301334	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company of America	301334	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Casualty	3/3/2016	11/26/2024
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Property	3/3/2016	11/26/2024
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	9/26/2019	12/15/2020
Active	Travelers Personal Insurance Company	705785	Agent - Casualty	11/11/2019
Active	Travelers Personal Insurance Company	705785	Agent - Property	11/11/2019
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	9/26/2019	12/15/2020
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Trustgard Insurance Company	300104	Agent - Property	2/12/2020	12/10/2020
Active	United Financial Casualty Company	301886	Agent - Casualty	4/29/2014
Active	United Financial Casualty Company	301886	Agent - Property	4/29/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Greene, Angela Louise	833810	Agent - Casualty	3/11/2014	12/31/2015
Inactive	Greene, Angela Louise	833810	Agent - Property	3/11/2014	12/31/2015
Active	Self, Charles E	526293	Agent - Casualty	3/3/2016
Active	Self, Charles E	526293	Agent - Health	10/9/2020
Active	Self, Charles E	526293	Agent - Life	10/9/2020
Active	Self, Charles E	526293	Agent - Property	3/3/2016
Inactive	Sutton, Crystal Renae	667735	Agent - Casualty	10/9/2020	3/31/2025
Inactive	Sutton, Crystal Renae	667735	Agent - Property	10/9/2020	3/31/2025
Active	Wilson, Hannah Lillian	986331	Agent - Casualty	10/9/2020
Active	Wilson, Hannah Lillian	986331	Agent - Property	10/9/2020