DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Worthman, Dustin	DOIID	1044620	NAIC NPN	17202080

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	6/19/2019		8/31/2025
Active	Non Resident	Agent	Property	6/19/2019		8/31/2025
* 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	06/15/2025	08/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	GuideOne Elite Insurance Company	300490	Agent - Casualty	8/12/2019
Active	GuideOne Elite Insurance Company	300490	Agent - Property	8/12/2019
Active	GuideOne Insurance Company	301794	Agent - Casualty	8/12/2019
Active	GuideOne Insurance Company	301794	Agent - Property	8/12/2019
Active	GuideOne Specialty Insurance Company	300278	Agent - Casualty	8/12/2019
Active	GuideOne Specialty Insurance Company	300278	Agent - Property	8/12/2019
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Casualty	8/30/2022
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Property	8/30/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Cobb B LLC	803227	Agent - Casualty	8/12/2019
Active	Cobb B LLC	803227	Agent - Property	8/12/2019