DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Carbajal, Samuel E	DOIID	808615	NAIC NPN	16942407

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Personal Lines	4/23/2013	2/29/2020
* 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	Nationwide Insurance Company of America	300333	Agent - Personal Lines	5/16/2013	3/4/2019
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Personal Lines	5/16/2013	3/4/2019
Inactive	Progressive Casualty Insurance Company	300696	Agent - Personal Lines	6/4/2013	4/8/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Personal Lines	5/21/2013	4/8/2019