DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Forker, David Michael	DOIID	826404	NAIC NPN	8485943

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	11/1/2013		10/31/2024
Active	Non Resident	Agent	Casualty	11/1/2013		10/31/2024
* 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	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Nationwide Insurance Company of America	300333	Agent - Casualty	11/6/2013
Active	Nationwide Insurance Company of America	300333	Agent - Property	11/6/2013
Inactive	Nationwide Mutual Fire Insurance Company	301722	Agent - Casualty	2/7/2014	1/1/2023
Inactive	Nationwide Mutual Fire Insurance Company	301722	Agent - Property	2/7/2014	1/1/2023
Active	Nationwide Mutual Insurance Company	301749	Agent - Casualty	1/1/2023
Active	Nationwide Mutual Insurance Company	301749	Agent - Property	1/1/2023
Active	Nationwide Property and Casualty Insurance Company	300599	Agent - Casualty	11/6/2013
Active	Nationwide Property and Casualty Insurance Company	300599	Agent - Property	11/6/2013
Inactive	Titan Indemnity Company	300556	Agent - Casualty	11/6/2013	8/22/2018
Inactive	Titan Indemnity Company	300556	Agent - Property	11/6/2013	8/22/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Nationwide Sales Solutions Inc	631821	Agent - Casualty	10/3/2017
Active	Nationwide Sales Solutions Inc	631821	Agent - Property	10/3/2017