Individual Information

GEROD R VERNON

TAMPA, FL 33635-9699

Active

gvernon@insuranceconsultantsofamerica.com

03/26/2018

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3324862	03/26/2018	Active	03/26/2018	03/31/2027

Qualification Type	Original Issue Date	Status	Effective Date
Health	03/26/2018	Active	03/26/2018
Life	03/26/2018	Active	03/26/2018
Limited Travel Baggage	09/21/2021	Active	09/21/2021

Company Name	Appointment Type	Status	Active Date
12315
AMALGAMATED LIFE INSURANCE COMPANY	Health	Active	05/16/2018
	Life	Active	05/16/2018
104
Company Name	Appointment Type	Status	Active Date
AMERITAS LIFE INSURANCE CORPORATION	Health	Active	10/09/2019
	Life	Active	10/09/2019
1266
Company Name	Appointment Type	Status	Active Date
LIFESHIELD NATIONAL INSURANCE CO.	Health	Active	04/25/2018
442
Company Name	Appointment Type	Status	Active Date
NATIONAL GUARDIAN LIFE INSURANCE COMPANY	Health	Active	02/07/2019
	Life	Active	02/07/2019
459
Company Name	Appointment Type	Status	Active Date
NATIONWIDE LIFE INSURANCE COMPANY	Health	Active	06/19/2018
	Life	Active	06/19/2018
1208
Company Name	Appointment Type	Status	Active Date
PAN-AMERICAN LIFE INSURANCE COMPANY	Health	Active	11/16/2022
692
Company Name	Appointment Type	Status	Active Date
UNITED STATES FIRE INSURANCE COMPANY	Health	Active	09/21/2020
714
Company Name	Appointment Type	Status	Active Date
WASHINGTON NATIONAL INSURANCE COMPANY	Health	Active	09/25/2019
	Life	Active	09/25/2019

row(s) 1 - 13 of 13

Organization	Association Type	Type	Beg dte	End dte
AMERICAN SERVICE INSURANCE AGENCY LLC	Designated Resp Lic Prdcr	Agency	11/17/2020	-
HEALTH PLAN INTERMEDIARIES HOLDINGS LLC	Designated Resp Lic Prdcr	Agency	08/01/2021	-
HEALTHPOCKET INC	Designated Resp Lic Prdcr	Agency	06/02/2021	-
HEALTH PLAN INTERMEDIARIES HOLDINGS, LLC	Designated Resp Lic Prdcr	Agency	12/29/2021	-

1 - 4