DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Nisenson, Adam	DOIID	1050804	NAIC NPN	17022029

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	8/8/2019		7/31/2026
Active	Non Resident	Agent	Property	8/8/2019		7/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	10/31/2019		7/31/2026
* 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	05/15/2024	07/31/2024	05/17/2024	05/17/2024	Yes
Surplus Lines Broker	05/15/2024	07/31/2024	05/17/2024	05/17/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Fireman's Fund Insurance Company	301423	Agent - Casualty	8/26/2019
Active	Fireman's Fund Insurance Company	301423	Agent - Property	8/26/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arthur J Gallagher & Co Ins Brokers Of California Inc	513894	Agent - Casualty	9/6/2019	2/12/2024
Inactive	Arthur J Gallagher & Co Ins Brokers Of California Inc	513894	Agent - Property	9/6/2019	2/12/2024
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Surplus Lines Broker - Not Applicable	11/20/2019