DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Werner, John J	DOIID	933053	NAIC NPN	17835275

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	10/13/2016		4/30/2027
Active	Non Resident	Agent	Health	10/13/2016		4/30/2027
Active	Non Resident	Agent	Casualty	10/13/2016		4/30/2027
Active	Non Resident	Agent	Property	10/13/2016		4/30/2027
Active	Non Resident	Surplus Lines Broker	Not Applicable	1/12/2023		4/30/2027
* 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
Active	Country Mutual Insurance Company	301024	Agent - Casualty	3/20/2018
Active	Country Mutual Insurance Company	301024	Agent - Property	3/20/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Tis Ins Services Inc	523150	Agent - Casualty	3/11/2020
Active	Tis Ins Services Inc	523150	Agent - Property	3/11/2020
Pending	Tis Ins Services Inc	523150	Agent - Life
Pending	Tis Ins Services Inc	523150	Agent - Health
Active	Tis Ins Services Inc	523150	Surplus Lines Broker - Not Applicable	5/8/2023