DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Gysbers, Simon	DOIID	1019983	NAIC NPN	18958805

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Pending Replacement	Non Resident	Agent	Casualty	8/21/2019		5/31/2025
Pending Replacement	Non Resident	Agent	Property	8/21/2019		5/31/2025
Pending Replacement	Non Resident	Agent	Personal Lines	11/21/2018		5/31/2025
* 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	03/15/2025	05/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Essentia Insurance Company	300342	Agent - Casualty	9/10/2019	11/28/2023
Inactive	Essentia Insurance Company	300342	Agent - Personal Lines	12/6/2018	11/28/2023
Inactive	Essentia Insurance Company	300342	Agent - Property	9/10/2019	11/28/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Hagerty Ins Agency LLC	541031	Agent - Personal Lines	12/6/2018	11/28/2023