DEPARTMENT OF INSURANCE

Affiliations

Name	Jacobs, Ann Marie	DOIID	845230	NAIC NPN	17316515

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Property	1/25/2016		5/31/2026
Active	Resident	Agent	Casualty	1/25/2016		5/31/2026
Active	Resident	Agent	Life	7/15/2014		5/31/2026
Active	Resident	Agent	Health	7/15/2014		5/31/2026
Inactive	Resident	Independent Adjuster	Property & Casualty	2/5/2016	5/31/2022
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	03/15/2024	05/31/2024	05/30/2024	05/30/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Economy Insurance Company	300315	Agent - Casualty	11/29/2023
Active	American Economy Insurance Company	300315	Agent - Property	11/29/2023
Inactive	Anthem Life Insurance Company	301209	Agent - Health	4/18/2015	6/29/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Life	4/15/2017	6/29/2021
Inactive	Athene Annuity and Life Company	301893	Agent - Life	5/16/2018	12/16/2019
Active	Erie Family Life Insurance Company	301400	Agent - Health	2/11/2019
Active	Erie Family Life Insurance Company	301400	Agent - Life	12/1/2018
Active	Erie Insurance Company	300230	Agent - Casualty	12/1/2018
Active	Erie Insurance Company	300230	Agent - Property	12/1/2018
Active	Erie Insurance Company of New York	789916	Agent - Casualty	12/1/2018
Active	Erie Insurance Company of New York	789916	Agent - Property	12/1/2018
Active	Erie Insurance Exchange	300789	Agent - Casualty	12/1/2018
Active	Erie Insurance Exchange	300789	Agent - Property	12/1/2018
Active	Erie Insurance Property & Casualty Company	789942	Agent - Casualty	12/1/2018
Active	Erie Insurance Property & Casualty Company	789942	Agent - Property	12/1/2018
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	2/21/2018	1/9/2020
Active	Flagship City Insurance Company	789965	Agent - Casualty	12/1/2018
Active	Flagship City Insurance Company	789965	Agent - Property	12/1/2018
Active	Forethought Life Insurance Company	301407	Agent - Health	9/28/2020
Active	Forethought Life Insurance Company	301407	Agent - Life	9/28/2020
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	4/23/2015	12/8/2015
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	4/23/2015	12/8/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	4/23/2015	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Health	4/23/2015	8/11/2016
Inactive	Humana Insurance Company	301104	Agent - Life	4/23/2015	8/11/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	4/23/2015	12/8/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	4/23/2015	12/8/2015
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	4/23/2015	12/8/2015
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/23/2015	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/23/2015	10/22/2015
Inactive	LifeShield National Insurance Company	737111	Agent - Life	8/29/2017	1/19/2023
Active	Milbank Insurance Company	925185	Agent - Casualty	2/4/2020
Active	Milbank Insurance Company	925185	Agent - Property	2/4/2020
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	11/12/2014	12/23/2016
Inactive	Omaha Insurance Company	751908	Agent - Health	11/12/2014	12/23/2016
Active	Plaza Insurance Company	300748	Agent - Casualty	1/7/2022
Active	Plaza Insurance Company	300748	Agent - Property	1/7/2022
Inactive	Pruco Life Insurance Company	300954	Agent - Life	12/30/2014	12/22/2016
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	12/14/2023
Active	SAFECO Insurance Company of America	300159	Agent - Property	12/14/2023
Active	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	1/2/2023
Active	SAFECO Insurance Company of Illinois	301350	Agent - Property	1/2/2023
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	2/8/2021
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	2/8/2021
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	11/12/2014	12/23/2016
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	11/12/2014	12/23/2016
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	2/19/2018	1/18/2019
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	2/19/2018	12/21/2018
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	1/18/2019
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	2/19/2018	1/18/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Blue Chip Insurance And Wealth Management	921846	Agent - Life	11/9/2017
Active	Blue Chip Insurance And Wealth Management	921846	Agent - Health	7/21/2016
Active	Blue Chip Insurance And Wealth Management	921846	Agent - Casualty	11/9/2017
Active	Blue Chip Insurance And Wealth Management	921846	Agent - Property	11/9/2017
Inactive	Futurity First Insurance Group LLC	676947	Agent - Life	5/9/2018	8/14/2019
Inactive	Futurity First Insurance Group LLC	676947	Agent - Health	5/9/2018	8/14/2019
Inactive	Medlink Inc	400721	Agent - Life	4/18/2015	12/23/2016
Inactive	Medlink Inc	400721	Agent - Health	4/18/2015	3/31/2024