DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Petersen, Diane L	DOIID	828195	NAIC NPN	15765640

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	11/22/2013	6/30/2021
Inactive	Non Resident	Agent	Property	11/22/2013	6/30/2021
* 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	American Reliable Insurance Company	301889	Agent - Casualty	4/7/2014	5/10/2017
Inactive	American Reliable Insurance Company	301889	Agent - Property	4/7/2014	5/10/2017
Inactive	American Security Insurance Company	300901	Agent - Casualty	4/7/2014	10/12/2016
Inactive	American Security Insurance Company	300901	Agent - Property	4/7/2014	10/12/2016
Inactive	Markel American Insurance Company	300377	Agent - Casualty	10/29/2019	6/30/2021
Inactive	Markel American Insurance Company	300377	Agent - Property	10/29/2019	6/30/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Specialty Program Group LLC	937234	Agent - Property	10/29/2019	6/30/2021
Inactive	Specialty Program Group LLC	937234	Agent - Casualty	10/29/2019	6/30/2021