DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Guillen Palomino, Derek	DOIID	895278	NAIC NPN	17747318

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	7/20/2023		7/31/2026
Active	Non Resident	Agent	Property	7/20/2023		7/31/2026
* 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	05/15/2024	07/31/2024	06/13/2024	06/13/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Permanent General Assurance Corporation	300883	Agent - Casualty	7/24/2023	1/8/2024
Active	Permanent General Assurance Corporation of Ohio	709250	Agent - Casualty	1/8/2024
Inactive	Praetorian Insurance Company	301021	Agent - Casualty	11/29/2017	2/21/2019
Inactive	Praetorian Insurance Company	301021	Agent - Property	11/29/2017	2/21/2019
Inactive	QBE Insurance Corporation	300515	Agent - Casualty	11/29/2017	2/21/2019
Inactive	QBE Insurance Corporation	300515	Agent - Property	11/29/2017	2/21/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	General Automobile Ins Services Inc	706632	Agent - Casualty	8/1/2023	1/8/2024
Inactive	General Automobile Ins Services Of Ohio Inc The	719262	Agent - Casualty	8/1/2023	1/8/2024
Inactive	Westwood Insurance Agency, LLC	534091	Agent - Property	11/29/2017	2/21/2019
Inactive	Westwood Insurance Agency, LLC	534091	Agent - Casualty	11/29/2017	2/21/2019