DEPARTMENT OF INSURANCE

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		4/30/2025
Active	Non Resident	Agent	Health	10/13/2016		4/30/2025
Active	Non Resident	Agent	Casualty	10/13/2016		4/30/2025
Active	Non Resident	Agent	Property	10/13/2016		4/30/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	1/12/2023		4/30/2025
* 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	02/15/2025	04/30/2025
Surplus Lines Broker	02/15/2025	04/30/2025

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
Denied	Tis Ins Services Inc	523150	Agent - Life
Denied	Tis Ins Services Inc	523150	Agent - Health
Active	Tis Ins Services Inc	523150	Surplus Lines Broker - Not Applicable	5/8/2023