DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Grucza, Douglas Andrew	DOIID	816224	NAIC NPN	2356076

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	8/5/2013	4/30/2015
Inactive	Non Resident	Agent	Health	8/1/2013	4/30/2015
Inactive	Non Resident	Agent	Life	8/1/2013	4/30/2015
* 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	Hartford Life and Accident Insurance Company	300878	Agent - Health	10/4/2013	5/30/2015
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	10/4/2013	5/30/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Lifetime Benefit Solutions, Inc.	574373	Agent - Life	11/11/2013	4/30/2015
Inactive	Lifetime Benefit Solutions, Inc.	574373	Agent - Health	11/11/2013	4/30/2015
Inactive	Lifetime Benefit Solutions, Inc.	574373	Administrator - Not Applicable	8/12/2013	11/13/2013