DEPARTMENT OF INSURANCE

Affiliations

Name	Dick, Samantha	DOIID	832325	NAIC NPN	17177675

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Casualty	3/18/2014	5/1/2017
Inactive	Resident	Agent	Property	3/25/2014	5/1/2017
* 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 Modern Home Insurance Company	300791	Agent - Casualty	9/2/2015	5/1/2017
Inactive	American Modern Home Insurance Company	300791	Agent - Property	9/2/2015	5/1/2017
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	9/2/2015	5/1/2017
Inactive	American Modern Select Insurance Company	581481	Agent - Property	9/2/2015	5/1/2017
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	9/22/2014	5/1/2017
Inactive	Bristol West Insurance Company	301655	Agent - Property	9/22/2014	5/1/2017
Inactive	Celina Mutual Insurance Company (The)	301908	Agent - Casualty	9/23/2014	5/1/2017
Inactive	Celina Mutual Insurance Company (The)	301908	Agent - Property	9/23/2014	5/1/2017
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	10/1/2014	5/1/2017
Inactive	Dairyland Insurance Company	301370	Agent - Property	10/1/2014	5/1/2017
Inactive	GuideOne Elite Insurance Company	300490	Agent - Casualty	10/1/2014	5/1/2017
Inactive	GuideOne Elite Insurance Company	300490	Agent - Property	10/1/2014	5/1/2017
Inactive	GuideOne Insurance Company	301794	Agent - Casualty	10/1/2014	5/1/2017
Inactive	GuideOne Insurance Company	301794	Agent - Property	10/1/2014	5/1/2017
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Casualty	10/1/2014	5/1/2017
Inactive	GuideOne Specialty Insurance Company	300278	Agent - Property	10/1/2014	5/1/2017
Inactive	Kentucky National Insurance Company	301625	Agent - Casualty	9/18/2014	5/1/2017
Inactive	Kentucky National Insurance Company	301625	Agent - Property	9/18/2014	5/1/2017
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	10/6/2014	5/1/2017
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	10/6/2014	5/1/2017
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	10/6/2014	5/1/2017
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	10/6/2014	5/1/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fox Insurance Agency.	563772	Agent - Casualty	9/18/2014	5/1/2017
Inactive	Fox Insurance Agency.	563772	Agent - Property	9/18/2014	5/1/2017