DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Groome, Tate	DOIID	955005	NAIC NPN	7820189

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	5/19/2017		5/31/2027
Active	Non Resident	Agent	Health	5/19/2017		5/31/2027
* 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	03/15/2025	05/31/2025	03/04/2025	03/04/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Allianz Life Insurance Company of North America	301791	Agent - Life	7/17/2023
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	5/22/2017	10/12/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	5/22/2017	10/12/2020
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	5/22/2017	10/5/2021
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	5/22/2017	10/5/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Executive Ins Agency Inc	400244	Agent - Life	2/15/2019	10/5/2021
Inactive	Executive Ins Agency Inc	400244	Agent - Health	2/15/2019	10/5/2021