Individual Information

LAWRENCE DEAN HILTON

ALPINE, UT 84004-1999

Active

larry.hilton@dominioninsurance.com

09/22/2004

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	194106	09/22/2004	Active	09/22/2004	09/30/2028
Non-Res. Surplus Lines Broker	201691	03/28/2005	Active	03/28/2005	03/31/2026

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	09/22/2004	Active	09/22/2004
Health	09/22/2004	Active	09/22/2004
Life	09/22/2004	Active	09/22/2004
Personal Lines	09/22/2004	Active	09/22/2004
Property	09/22/2004	Active	09/22/2004
Surplus Lines	03/28/2005	Active	08/14/2014

Company Name	Appointment Type	Status	Active Date
1200
FARMINGTON CASUALTY COMPANY	Casualty	Active	05/29/2020
	Property	Active	05/29/2020
305
Company Name	Appointment Type	Status	Active Date
GREENWICH INSURANCE COMPANY	Casualty	Active	07/14/2015
	Property	Active	07/14/2015
309
Company Name	Appointment Type	Status	Active Date
HARTFORD FIRE INSURANCE COMPANY	Casualty	Active	03/04/2012
	Property	Active	03/04/2012
146052
Company Name	Appointment Type	Status	Active Date
SELECTHEALTH INC	Health	Active	06/01/2023
608
Company Name	Appointment Type	Status	Active Date
STANDARD FIRE INSURANCE COMPANY (THE)	Casualty	Active	05/29/2020
	Property	Active	05/29/2020
4
Company Name	Appointment Type	Status	Active Date
TRAVELERS CASUALTY AND SURETY COMPANY	Casualty	Active	05/29/2020
	Property	Active	05/29/2020
725
Company Name	Appointment Type	Status	Active Date
WESTFIELD INSURANCE COMPANY	Casualty	Active	11/03/2025
	Property	Active	11/03/2025
167282
Company Name	Appointment Type	Status	Active Date
WESTFIELD SELECT INSURANCE COMPANY	Casualty	Active	11/03/2025
	Property	Active	11/03/2025

row(s) 1 - 15 of 15

Organization	Association Type	Type	Beg dte	End dte
DOMINION INS SERVICES INC	Designated Resp Lic Prdcr	Agency	05/01/2020	-

1 - 1