DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ellis, Jacob Owen	DOIID	840875	NAIC NPN	17270652

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	6/12/2014	7/31/2015
Inactive	Resident	Agent	Health	6/13/2014	7/31/2015
Inactive	Resident	Agent	Casualty	6/17/2014	7/31/2015
Inactive	Resident	Agent	Property	6/19/2014	7/31/2015
* 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	7/25/2014	7/31/2015
Inactive	American Modern Home Insurance Company	300791	Agent - Property	7/25/2014	7/31/2015
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	7/25/2014	3/10/2015
Inactive	American Modern Select Insurance Company	581481	Agent - Property	7/25/2014	3/10/2015
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	7/25/2014	3/10/2015
Inactive	American Southern Home Insurance Company	626276	Agent - Property	7/25/2014	3/10/2015
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	7/22/2014	3/20/2015
Inactive	Bristol West Insurance Company	301655	Agent - Property	7/22/2014	3/20/2015
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	7/23/2014	3/17/2015
Inactive	Dairyland Insurance Company	301370	Agent - Property	7/23/2014	3/17/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	7/22/2014	3/20/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	7/22/2014	3/20/2015
Inactive	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Casualty	7/7/2014	2/5/2015
Inactive	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Health	7/7/2014	2/5/2015
Inactive	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Property	7/7/2014	2/5/2015
Inactive	Southern Farm Bureau Life Insurance Company	300909	Agent - Health	7/7/2014	2/5/2015
Inactive	Southern Farm Bureau Life Insurance Company	300909	Agent - Life	7/7/2014	2/5/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	7/9/2014	2/5/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Health	7/9/2014	2/5/2015
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Casualty	7/7/2014	1/30/2015
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Life	7/7/2014	1/30/2015
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Health	7/7/2014	1/30/2015
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Property	7/7/2014	1/30/2015