DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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		10/31/2026
Active	Non Resident	Agent	Casualty	11/1/2013		10/31/2026
* 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
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