DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Selfridge, Thomas Mark	DOIID	801137	NAIC NPN	16531017

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	1/10/2013	10/22/2015
Inactive	Non Resident	Agent	Casualty	1/10/2013	10/22/2015
* 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	American Family Home Insurance Company	301817	Agent - Casualty	6/15/2015	10/22/2015
Inactive	American Family Home Insurance Company	301817	Agent - Property	6/15/2015	10/22/2015
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	7/31/2013	10/16/2015
Inactive	American Modern Home Insurance Company	300791	Agent - Property	7/31/2013	10/16/2015
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	7/31/2013	10/16/2015
Inactive	American Modern Select Insurance Company	581481	Agent - Property	7/31/2013	10/16/2015
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	7/31/2013	10/16/2015
Inactive	American Southern Home Insurance Company	626276	Agent - Property	7/31/2013	10/16/2015
Inactive	Electric Insurance Company	301758	Agent - Casualty	1/16/2013	10/13/2015
Inactive	Electric Insurance Company	301758	Agent - Property	1/16/2013	10/13/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/12/2013	10/22/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/12/2013	10/22/2015
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	2/26/2013	10/22/2015
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	2/26/2013	10/22/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Electric Insurance Agency, LLC	521813	Agent - Property	1/28/2013	10/13/2015
Inactive	Electric Insurance Agency, LLC	521813	Agent - Casualty	1/28/2013	10/13/2015