DEPARTMENT OF INSURANCE

Affiliations

Name	Self Insurance Services, LLC	DOIID	792398	NAIC NPN	8527294

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	10/9/2020	3/31/2026
Active	Non Resident	Agent	Property	2/21/2014	3/31/2026
Active	Non Resident	Agent	Health	10/9/2020	3/31/2026
Active	Non Resident	Agent	Casualty	2/21/2014	3/31/2026
* 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	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	AMCO Insurance Company	300204	Agent - Casualty	8/18/2017
Active	AMCO Insurance Company	300204	Agent - Property	8/18/2017
Inactive	All Savers Insurance Company	301940	Agent - Health	7/24/2013	7/25/2013
Inactive	All Savers Insurance Company	301940	Agent - Life	7/24/2013	7/25/2013
Active	Allied Insurance Company of America	793586	Agent - Casualty	8/18/2017
Active	Allied Insurance Company of America	793586	Agent - Property	8/18/2017
Active	Allied Property and Casualty Insurance Company	300279	Agent - Casualty	8/18/2017
Active	Allied Property and Casualty Insurance Company	300279	Agent - Property	8/18/2017
Inactive	American Economy Insurance Company	300315	Agent - Casualty	11/9/2019	3/29/2024
Inactive	American Economy Insurance Company	300315	Agent - Property	11/9/2019	3/29/2024
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	10/7/2019
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Property	10/7/2019
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	3/3/2016	11/30/2017
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	3/3/2016	11/30/2017
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	10/31/2021	12/20/2024
Inactive	Bristol West Insurance Company	301655	Agent - Property	10/31/2021	12/20/2024
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	9/26/2019	12/15/2020
Active	Depositors Insurance Company	301634	Agent - Casualty	8/18/2017
Active	Depositors Insurance Company	301634	Agent - Property	8/18/2017
Inactive	Encompass Indemnity Company	546376	Agent - Casualty	3/23/2021	10/3/2024
Inactive	Encompass Indemnity Company	546376	Agent - Property	3/23/2021	10/3/2024
Active	Erie Family Life Insurance Company	301400	Agent - Health	9/15/2023
Active	Erie Family Life Insurance Company	301400	Agent - Life	9/15/2023
Active	Erie Insurance Company	300230	Agent - Casualty	9/15/2023
Active	Erie Insurance Company	300230	Agent - Property	9/15/2023
Active	Erie Insurance Company of New York	789916	Agent - Casualty	2/23/2018
Active	Erie Insurance Company of New York	789916	Agent - Property	2/23/2018
Active	Erie Insurance Exchange	300789	Agent - Casualty	2/23/2018
Active	Erie Insurance Exchange	300789	Agent - Property	2/23/2018
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	9/12/2018	4/26/2024
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	9/12/2018	4/26/2024
Inactive	Farmington Casualty Company	301137	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Farmington Casualty Company	301137	Agent - Property	9/26/2019	12/15/2020
Active	Flagship City Insurance Company	789965	Agent - Casualty	2/23/2018
Active	Flagship City Insurance Company	789965	Agent - Property	2/23/2018
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	2/25/2014
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	2/25/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	9/21/2017	5/3/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	9/21/2017	5/3/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	9/21/2017	5/3/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	9/21/2017	5/3/2018
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	2/12/2020	12/10/2020
Inactive	Grange Insurance Company	300234	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Grange Insurance Company	300234	Agent - Property	2/12/2020	12/10/2020
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Property	2/12/2020	12/10/2020
Inactive	John Alden Life Insurance Company	300573	Agent - Health	10/2/2012	3/20/2013
Inactive	John Alden Life Insurance Company	300573	Agent - Life	10/2/2012	3/20/2013
Inactive	Meridian Security Insurance Company	300423	Agent - Casualty	9/28/2018	2/12/2025
Inactive	Meridian Security Insurance Company	300423	Agent - Property	9/28/2018	2/12/2025
Active	Milbank Insurance Company	925185	Agent - Casualty	9/28/2018
Active	Milbank Insurance Company	925185	Agent - Property	9/28/2018
Active	Nationwide Agribusiness Insurance Company	301008	Agent - Casualty	8/18/2017
Active	Nationwide Agribusiness Insurance Company	301008	Agent - Property	8/18/2017
Active	Nationwide Assurance Company	300166	Agent - Casualty	3/4/2020
Active	Nationwide General Insurance Company	300603	Agent - Casualty	8/28/2019
Active	Nationwide General Insurance Company	300603	Agent - Property	8/28/2019
Active	Nationwide Insurance Company of America	300333	Agent - Casualty	8/28/2019
Active	Nationwide Insurance Company of America	300333	Agent - Property	8/28/2019
Active	Nationwide Mutual Insurance Company	301749	Agent - Casualty	8/18/2017
Active	Nationwide Mutual Insurance Company	301749	Agent - Property	8/18/2017
Active	Nationwide Property and Casualty Insurance Company	300599	Agent - Casualty	2/2/2022
Active	Nationwide Property and Casualty Insurance Company	300599	Agent - Property	2/2/2022
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	10/13/2020	3/29/2024
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	10/13/2020	3/29/2024
Active	Progressive Casualty Insurance Company	300696	Agent - Casualty	4/29/2014
Active	Progressive Casualty Insurance Company	300696	Agent - Property	4/29/2014
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	6/26/2024
Active	SAFECO Insurance Company of America	300159	Agent - Property	6/26/2024
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/2/2018	3/29/2024
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/2/2018	3/29/2024
Active	Selective Insurance Company of the Southeast	300381	Agent - Casualty	3/29/2018
Active	Selective Insurance Company of the Southeast	300381	Agent - Property	3/29/2018
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Casualty	8/10/2023	11/26/2024
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Property	8/10/2023	11/26/2024
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	3/3/2016	11/26/2024
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	3/3/2016	11/26/2024
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	6/11/2014	2/1/2016
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	6/11/2014	2/1/2016
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - Casualty	9/28/2018	2/12/2025
Inactive	State Auto Property & Casualty Insurance Company	301953	Agent - Property	9/28/2018	2/12/2025
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	9/28/2018	2/12/2025
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	9/28/2018	2/12/2025
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	9/25/2018	11/26/2024
Inactive	The Phoenix Insurance Company	301502	Agent - Property	9/25/2018	11/26/2024
Inactive	Time Insurance Company	300683	Agent - Health	9/26/2012	12/20/2014
Inactive	Time Insurance Company	300683	Agent - Life	9/26/2012	12/20/2014
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company of America	301334	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Casualty and Surety Company of America	301334	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Casualty	3/3/2016	11/26/2024
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Property	3/3/2016	11/26/2024
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	9/26/2019	12/15/2020
Active	Travelers Personal Insurance Company	705785	Agent - Casualty	11/11/2019
Active	Travelers Personal Insurance Company	705785	Agent - Property	11/11/2019
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	9/26/2019	12/15/2020
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	9/26/2019	12/15/2020
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	2/12/2020	12/10/2020
Inactive	Trustgard Insurance Company	300104	Agent - Property	2/12/2020	12/10/2020
Active	United Financial Casualty Company	301886	Agent - Casualty	4/29/2014
Active	United Financial Casualty Company	301886	Agent - Property	4/29/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Greene, Angela Louise	833810	Agent - Casualty	3/11/2014	12/31/2015
Inactive	Greene, Angela Louise	833810	Agent - Property	3/11/2014	12/31/2015
Active	Self, Charles E	526293	Agent - Casualty	3/3/2016
Active	Self, Charles E	526293	Agent - Health	10/9/2020
Active	Self, Charles E	526293	Agent - Life	10/9/2020
Active	Self, Charles E	526293	Agent - Property	3/3/2016
Inactive	Sutton, Crystal Renae	667735	Agent - Casualty	10/9/2020	3/31/2025
Inactive	Sutton, Crystal Renae	667735	Agent - Property	10/9/2020	3/31/2025
Active	Wilson, Hannah Lillian	986331	Agent - Casualty	10/9/2020
Active	Wilson, Hannah Lillian	986331	Agent - Property	10/9/2020