DEPARTMENT OF INSURANCE

Affiliations

Name	Champion, Chasta Nicole	DOIID	800661	NAIC NPN	16859874

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Casualty	4/2/2013	12/1/2015
Inactive	Resident	Agent	Property	4/2/2013	12/1/2015
* 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	Allstate Indemnity Company	300778	Agent - Casualty	4/17/2013	12/1/2015
Inactive	Allstate Indemnity Company	300778	Agent - Property	4/17/2013	12/1/2015
Inactive	Allstate Insurance Company	300773	Agent - Casualty	4/17/2013	12/1/2015
Inactive	Allstate Insurance Company	300773	Agent - Property	4/17/2013	12/1/2015
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	4/17/2013	12/1/2015
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	4/17/2013	12/1/2015
Inactive	Allstate Vehicle & Property Insurance Company	301429	Agent - Casualty	2/19/2014	12/1/2015
Inactive	Allstate Vehicle & Property Insurance Company	301429	Agent - Property	2/19/2014	12/1/2015
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Casualty	4/19/2013	4/1/2014
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Property	4/19/2013	4/1/2014
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	7/2/2013	3/13/2014
Inactive	Bristol West Insurance Company	301655	Agent - Property	7/2/2013	3/13/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	7/2/2013	3/13/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	7/2/2013	3/13/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	7/2/2013	3/13/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	7/2/2013	3/13/2014
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	7/2/2013	3/13/2014
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	7/2/2013	3/13/2014
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	4/24/2013	1/24/2014
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	4/24/2013	1/24/2014
Inactive	Grange Insurance Company	300234	Agent - Casualty	4/24/2013	1/24/2014
Inactive	Grange Insurance Company	300234	Agent - Property	4/24/2013	1/24/2014
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	4/24/2013	1/24/2014
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Property	4/24/2013	1/24/2014
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	4/10/2013	11/11/2013
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	4/10/2013	11/11/2013
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	4/24/2013	1/24/2014
Inactive	Trustgard Insurance Company	300104	Agent - Property	4/24/2013	1/24/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Terry L Ford Insurance Agency Inc.	400352	Agent - Casualty	5/13/2013	4/1/2014
Inactive	Terry L Ford Insurance Agency Inc.	400352	Agent - Property	5/13/2013	4/1/2014