DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Henderson Gustafson, Ann Kimball	DOIID	830443	NAIC NPN	8329982

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	12/28/2013	6/30/2022
Inactive	Non Resident	Agent	Casualty	12/28/2013	6/30/2022
* 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	Privilege Underwriters Reciprocal Exchange	769657	Agent - Casualty	6/9/2021	6/30/2022
Inactive	Privilege Underwriters Reciprocal Exchange	769657	Agent - Property	6/9/2021	6/30/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Privilege Underwriters Insurance Agency	630090	Agent - Casualty
Denied	Privilege Underwriters Insurance Agency	630090	Agent - Property