DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fountain, Christopher Thomas	DOIID	860397	NAIC NPN	17279737

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	11/11/2014	12/31/2017
Inactive	Non Resident	Agent	Casualty	11/11/2014	12/31/2017
Inactive	Non Resident	Agent	Life	11/11/2014	12/31/2017
Inactive	Non Resident	Agent	Property	11/11/2014	12/31/2017
* 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	Massachusetts Mutual Life Insurance Company	300445	Agent - Health	6/1/2015	2/15/2017
Inactive	Medical Protective Company (The)	301207	Agent - Casualty	11/20/2014	2/10/2017
Inactive	Medical Protective Company (The)	301207	Agent - Property	11/20/2014	2/10/2017
Inactive	Principal Life Insurance Company	300129	Agent - Health	5/29/2015	12/31/2017
Inactive	Principal Life Insurance Company	300129	Agent - Life	5/29/2015	12/31/2017
Inactive	Principal National Life Insurance Company	301926	Agent - Life	6/5/2015	12/31/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Treloar & Heisel, Inc.	516754	Agent - Casualty	11/20/2014	2/10/2017
Inactive	Treloar & Heisel, Inc.	516754	Agent - Health	5/29/2015	2/23/2017
Inactive	Treloar & Heisel, Inc.	516754	Agent - Property	11/20/2014	2/10/2017
Inactive	Treloar & Heisel, Inc.	516754	Agent - Life	5/29/2015	2/23/2017