DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Dumois Diaz, Jorge Raul	DOIID	978036	NAIC NPN	18599556

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	5/4/2023		9/30/2026
Active	Non Resident	Agent	Property	5/4/2023		9/30/2026
Inactive	Non Resident	Agent	Health	11/30/2017	9/30/2020
* 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	07/18/2024	07/18/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	5/4/2023
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	5/4/2023
Active	American Modern Home Insurance Company	300791	Agent - Casualty	8/23/2023
Active	American Modern Home Insurance Company	300791	Agent - Property	8/23/2023
Active	Bristol West Insurance Company	301655	Agent - Casualty	7/24/2023
Active	Bristol West Insurance Company	301655	Agent - Property	7/24/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	7/24/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	7/24/2023
Active	Homesite Insurance Company	301139	Agent - Casualty	5/4/2023
Active	Homesite Insurance Company	301139	Agent - Property	5/4/2023
Active	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	5/4/2023
Active	Homesite Insurance Company of the Midwest	874850	Agent - Property	5/4/2023
Active	Midvale Indemnity Company	300292	Agent - Casualty	5/4/2023
Active	Midvale Indemnity Company	300292	Agent - Property	5/4/2023
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	11/30/2017	12/11/2018
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	11/30/2017	12/11/2018
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	12/11/2018
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	11/30/2017	12/11/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	6/21/2023
Active	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	6/21/2023