DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Crown Atlantic Insurance, LLC	DOIID	826646	NAIC NPN	17063026

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	11/4/2013		3/31/2027
Active	Non Resident	Agent	Health	11/4/2013		3/31/2027
* 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	01/15/2027	03/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Banner Life Insurance Company	301696	Agent - Life	7/16/2026
Active	Nationwide Life and Annuity Insurance Company	300714	Agent - Health	11/2/2015
Active	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	11/2/2015
Active	Security Benefit Life Insurance Company	300583	Agent - Health	9/19/2014
Active	Security Benefit Life Insurance Company	300583	Agent - Life	9/19/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Edwards, David	928295	Agent - Health	12/15/2016
Active	Edwards, David	928295	Agent - Life	12/15/2016
Inactive	Stark, Joseph D	825746	Agent - Health	7/27/2016	12/15/2016
Inactive	Stark, Joseph D	825746	Agent - Life	7/27/2016	12/15/2016