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.

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