DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Peterson, Manita A	DOIID	1279164	NAIC NPN	20458041

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	6/8/2023		11/30/2025
Active	Non Resident	Agent	Casualty	6/8/2023		11/30/2025
* 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	09/15/2025	11/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Independence American Insurance Company	524747	Agent - Casualty	9/11/2023
Active	Independence American Insurance Company	524747	Agent - Property	9/11/2023
Active	United States Fire Insurance Company	582240	Agent - Casualty	6/13/2023
Active	United States Fire Insurance Company	582240	Agent - Property	6/13/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	PTZ Insurance Agency LTD	695420	Agent - Casualty	8/14/2024
Active	PTZ Insurance Agency LTD	695420	Agent - Property	8/14/2024