DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Guillen, Jose	DOIID	868855	NAIC NPN	17497365

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	9/12/2016		9/30/2024
Active	Non Resident	Agent	Health	2/11/2015		9/30/2024
Active	Non Resident	Agent	Life	2/11/2015		9/30/2024
Active	Non Resident	Agent	Casualty	9/12/2016		9/30/2024
* 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	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Continental American Insurance Company	301700	Agent - Health	2/19/2015
Active	Continental American Insurance Company	301700	Agent - Life	2/19/2015
Active	National Casualty Company	301483	Agent - Casualty	9/22/2016
Active	National Casualty Company	301483	Agent - Property	9/22/2016
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	3/16/2015	7/29/2021
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/16/2015	7/29/2021
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	3/4/2015	12/18/2020
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	3/4/2015	12/18/2020
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	3/16/2015	7/29/2021
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	3/16/2015	7/29/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aptia Insurance Services Group LLC	1283785	Agent - Health	3/25/2024
Active	Aptia Insurance Services Group LLC	1283785	Agent - Life	3/25/2024
Active	DVM Insurance Agency	636779	Agent - Property	12/5/2016
Active	DVM Insurance Agency	636779	Agent - Casualty	12/5/2016
Active	Mercer Health & Benefits Administration LLC	656414	Agent - Health	1/15/2019
Active	Mercer Health & Benefits Administration LLC	656414	Agent - Life	1/15/2019
Active	Mercer Health & Benefits Administration LLC	656414	Agent - Property	1/15/2019
Active	Mercer Health & Benefits Administration LLC	656414	Agent - Casualty	1/15/2019