DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Gomez, Maryjane	DOIID	802789	NAIC NPN	15886538

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	2/1/2013	1/31/2019
Inactive	Non Resident	Agent	Property	2/1/2013	1/31/2019
Active	Non Resident	Staff Adjuster	Property & Casualty	4/13/2021		1/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Staff Adjuster	11/15/2026	01/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	21st Century North America Insurance Company	300884	Agent - Casualty	2/12/2013	1/4/2016
Inactive	21st Century North America Insurance Company	300884	Agent - Property	2/12/2013	1/4/2016
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	1/26/2016	1/31/2019
Inactive	Bristol West Insurance Company	301655	Agent - Property	1/26/2016	1/31/2019
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	4/24/2015	1/25/2016
Inactive	Dairyland Insurance Company	301370	Agent - Property	4/24/2015	1/25/2016
Inactive	Esurance Insurance Company	301072	Agent - Casualty	2/14/2013	1/21/2016
Inactive	Esurance Insurance Company	301072	Agent - Property	2/14/2013	1/21/2016
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	2/20/2014	12/17/2014
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	2/20/2014	12/17/2014
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	10/15/2013	1/21/2016
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	10/15/2013	1/21/2016
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	10/15/2013	1/21/2016
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	10/15/2013	1/21/2016
Inactive	Victoria Fire & Casualty Company	300313	Agent - Casualty	7/10/2013	1/26/2016
Inactive	Victoria Fire & Casualty Company	300313	Agent - Property	7/10/2013	1/26/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Quinstreet Insurance Agency, Inc.	633182	Agent - Property	2/12/2013	1/26/2016
Inactive	Quinstreet Insurance Agency, Inc.	633182	Agent - Casualty	2/12/2013	1/26/2016