DEPARTMENT OF INSURANCE

Affiliations

Name	Crockett, Elizabeth Wall	DOIID	802831	NAIC NPN	16205919

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Property	2/8/2013	8/31/2025
Active	Resident	Agent	Health	2/13/2013	8/31/2025
Active	Resident	Agent	Casualty	2/8/2013	8/31/2025
Active	Resident	Agent	Life	2/13/2013	8/31/2025
* 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
Agent	06/15/2025	08/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE American Insurance Company	300625	Agent - Casualty	5/19/2015
Active	ACE American Insurance Company	300625	Agent - Property	5/19/2015
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	6/7/2016	12/9/2020
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - Property	6/7/2016	12/9/2020
Inactive	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	6/7/2016	12/9/2020
Inactive	ACE Property and Casualty Insurance Company	300520	Agent - Property	6/7/2016	12/9/2020
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	8/24/2016	12/20/2023
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Property	8/24/2016	12/20/2023
Active	AIG Property Casualty Company	300621	Agent - Casualty	3/8/2016
Active	AIG Property Casualty Company	300621	Agent - Property	3/8/2016
Inactive	All Savers Insurance Company	301940	Agent - Health	7/7/2015	10/31/2023
Inactive	All Savers Insurance Company	301940	Agent - Life	7/7/2015	10/31/2023
Inactive	American General Life Insurance Company	301585	Agent - Health	12/9/2016	12/23/2019
Inactive	American General Life Insurance Company	301585	Agent - Life	12/9/2016	12/23/2019
Inactive	Anthem Life Insurance Company	301209	Agent - Health	3/26/2013	6/7/2017
Inactive	Anthem Life Insurance Company	301209	Agent - Life	3/26/2013	6/7/2017
Active	Bankers Standard Insurance Company	301620	Agent - Casualty	5/19/2015
Active	Bankers Standard Insurance Company	301620	Agent - Property	5/19/2015
Inactive	Banner Life Insurance Company	301696	Agent - Life	4/29/2013	10/22/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	3/5/2013	10/12/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	3/5/2013	10/12/2020
Active	Brighthouse Life Insurance Company	301829	Agent - Health	10/8/2014
Active	Brighthouse Life Insurance Company	301829	Agent - Life	10/8/2014
Active	Cincinnati Casualty Company (The)	300308	Agent - Casualty	2/26/2013
Active	Cincinnati Casualty Company (The)	300308	Agent - Property	2/26/2013
Active	Cincinnati Indemnity Company (The)	301566	Agent - Casualty	2/26/2013
Active	Cincinnati Indemnity Company (The)	301566	Agent - Property	2/26/2013
Active	Cincinnati Insurance Company	301298	Agent - Casualty	2/26/2013
Active	Cincinnati Insurance Company	301298	Agent - Property	2/26/2013
Active	Cincinnati Life Insurance Company (The)	300601	Agent - Health	2/26/2013
Active	Cincinnati Life Insurance Company (The)	300601	Agent - Life	2/26/2013
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	5/31/2013	12/13/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	1/13/2020	12/15/2020
Active	Forethought Life Insurance Company	301407	Agent - Health	7/15/2014
Active	Forethought Life Insurance Company	301407	Agent - Life	7/15/2014
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	7/22/2013	1/5/2015
Active	Guardian Life Insurance Company of America	301316	Agent - Health	3/5/2013
Active	Guardian Life Insurance Company of America	301316	Agent - Life	3/5/2013
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	5/31/2013	12/8/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	5/31/2013	12/13/2022
Inactive	Humana Insurance Company	301104	Agent - Health	5/31/2013	12/13/2022
Inactive	Humana Insurance Company	301104	Agent - Life	5/31/2013	12/13/2022
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	5/31/2013	6/15/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	1/13/2020	12/15/2020
Active	Indemnity Insurance Company of North America	301760	Agent - Casualty	5/19/2015
Active	Indemnity Insurance Company of North America	301760	Agent - Property	5/19/2015
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	1/27/2017	12/29/2020
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	1/27/2017	12/29/2020
Inactive	Kanawha Insurance Company	300127	Agent - Health	5/31/2013	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	5/31/2013	10/22/2015
Inactive	Kentucky Health Cooperative, Inc.	798780	Agent - Health	11/11/2013	10/29/2015
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	3/25/2019	10/18/2022
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	3/25/2019	10/18/2022
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Health	10/8/2014	11/14/2014
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	10/8/2014	11/14/2014
Active	Metropolitan Life Insurance Company	301948	Agent - Health	10/14/2013
Active	Metropolitan Life Insurance Company	301948	Agent - Life	10/14/2013
Inactive	Minnesota Life Insurance Company	300488	Agent - Health	2/12/2016	5/13/2022
Inactive	Minnesota Life Insurance Company	300488	Agent - Life	2/12/2016	5/13/2022
Inactive	Old Guard Insurance Company	533854	Agent - Casualty	6/4/2021	6/15/2021
Inactive	Old Guard Insurance Company	533854	Agent - Property	6/4/2021	6/15/2021
Active	Pacific Employers Insurance Company	301753	Agent - Casualty	5/19/2015
Active	Pacific Employers Insurance Company	301753	Agent - Property	5/19/2015
Active	Principal National Life Insurance Company	301926	Agent - Life	11/5/2015
Active	Privilege Underwriters Reciprocal Exchange	769657	Agent - Casualty	12/13/2016
Active	Privilege Underwriters Reciprocal Exchange	769657	Agent - Property	12/13/2016
Inactive	Protective Life Insurance Company	300638	Agent - Health	5/14/2014	11/23/2019
Inactive	Protective Life Insurance Company	300638	Agent - Life	5/14/2014	11/23/2019
Inactive	Pruco Life Insurance Company	300954	Agent - Life	7/28/2014	12/22/2016
Inactive	Time Insurance Company	300683	Agent - Health	10/25/2013	12/20/2014
Inactive	Time Insurance Company	300683	Agent - Life	10/25/2013	12/20/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	3/29/2017	3/27/2023
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	3/29/2017	3/27/2023
Inactive	Westfield Champion Insurance Company	1054839	Agent - Casualty	6/4/2021	6/15/2021
Inactive	Westfield Champion Insurance Company	1054839	Agent - Property	6/4/2021	6/15/2021
Active	Westfield Insurance Company	301950	Agent - Casualty	10/4/2017
Active	Westfield Insurance Company	301950	Agent - Property	10/4/2017
Inactive	Westfield Premier Insurance Company	1055055	Agent - Casualty	6/4/2021	6/15/2021
Inactive	Westfield Premier Insurance Company	1055055	Agent - Property	6/4/2021	6/15/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Casualty	6/4/2021	6/15/2021
Inactive	Westfield Superior Insurance Company	1054978	Agent - Property	6/4/2021	6/15/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Casualty	6/4/2021	6/15/2021
Inactive	Westfield Touchstone Insurance Company	1055057	Agent - Property	6/4/2021	6/15/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	3/26/2013	2/10/2025
Inactive	Designated Agent Company Inc.	681257	Agent - Life	3/26/2013	2/10/2025
Active	Planchoice Inc.	400482	Agent - Health	4/17/2014
Inactive	Sterling G. Thompson Co.	399153	Agent - Casualty	2/26/2013	12/8/2016
Inactive	Sterling G. Thompson Co.	399153	Agent - Property	2/26/2013	12/8/2016
Inactive	Sterling G. Thompson Co.	399153	Agent - Health	2/26/2013	12/8/2016
Inactive	Sterling G. Thompson Co.	399153	Agent - Life	2/26/2013	12/8/2016
Active	Sterling Thompson Company	935239	Agent - Casualty	11/7/2016
Active	Sterling Thompson Company	935239	Agent - Property	11/7/2016
Active	Sterling Thompson Company	935239	Agent - Health	11/7/2016
Active	Sterling Thompson Company	935239	Agent - Life	11/7/2016