DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Davis, Dominique Cothran	DOIID	842291	NAIC NPN	16904034

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	11/29/2022		3/31/2025
Active	Non Resident	Agent	Casualty	11/29/2022		3/31/2025
* 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	Amica Mutual Insurance Company	301405	Agent - Casualty	6/10/2014	2/2/2018
Inactive	Amica Mutual Insurance Company	301405	Agent - Property	6/10/2014	2/2/2018
Active	NLADA Mutual Insurance Co., a Risk Retention Group	1228232	Agent - Casualty	6/20/2023
Active	NLADA Mutual Insurance Co., a Risk Retention Group	1228232	Agent - Property	6/20/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Nlada Service Corporation	1223418	Agent - Casualty	6/20/2023
Active	Nlada Service Corporation	1223418	Agent - Property	6/20/2023