DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Amy	DOIID	824565	NAIC NPN	7479080

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	10/10/2014	6/30/2024
Inactive	Non Resident	Agent	Health	10/16/2013	6/30/2024
Inactive	Non Resident	Agent	Life	10/16/2013	6/30/2024
Inactive	Non Resident	Agent	Property	10/10/2014	6/30/2024
* 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	Continental American Insurance Company	301700	Agent - Health	10/28/2013	6/16/2016
Inactive	Continental American Insurance Company	301700	Agent - Life	10/28/2013	6/16/2016
Inactive	National Casualty Company	301483	Agent - Casualty	11/4/2014	6/30/2024
Inactive	National Casualty Company	301483	Agent - Property	11/4/2014	6/30/2024
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	11/6/2014	3/12/2016
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	11/6/2014	3/12/2016
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	8/27/2014	12/18/2020
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	8/27/2014	12/18/2020
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	11/6/2014	3/12/2016
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	11/6/2014	3/12/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Aptia Insurance Services Group LLC	1283785	Agent - Health
Denied	Aptia Insurance Services Group LLC	1283785	Agent - Life
Inactive	DVM Insurance Agency	636779	Agent - Casualty	11/5/2014	6/30/2024
Inactive	DVM Insurance Agency	636779	Agent - Property	11/5/2014	6/30/2024
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Health	1/15/2019	12/18/2020
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Life	1/15/2019	12/18/2020
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Casualty	1/15/2019	6/30/2024
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Property	1/15/2019	6/30/2024