DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Sample, Frances E	DOIID	982638	NAIC NPN	1946219

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	1/29/2018	3/10/2020
Inactive	Non Resident	Agent	Property	1/29/2018	3/10/2020
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	2/11/2018	3/10/2020
* 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
Inactive	Plaza Insurance Company	300748	Agent - Casualty	2/1/2018	3/10/2020
Inactive	Plaza Insurance Company	300748	Agent - Property	2/1/2018	3/10/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Rockhill Underwriting Mgmt LLC	655056	Agent - Property	2/28/2018	2/14/2020
Inactive	Rockhill Underwriting Mgmt LLC	655056	Agent - Casualty	2/28/2018	2/14/2020
Inactive	Rockhill Underwriting Mgmt LLC	655056	Surplus Lines Broker - Not Applicable	2/28/2018	2/14/2020