DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Hazley, Charles A	DOIID	1067370	NAIC NPN	17500769

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	12/9/2019	4/30/2021
Inactive	Non Resident	Agent	Property	12/9/2019	4/30/2021
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	12/17/2019	8/24/2020
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Property	12/17/2019	8/24/2020
Inactive	Wellfleet Insurance Company	300542	Agent - Casualty	8/7/2020	10/9/2020
Inactive	Wellfleet New York Insurance Company	300245	Agent - Casualty	8/7/2020	10/9/2020
Inactive	Wellfleet New York Insurance Company	300245	Agent - Property	8/7/2020	10/9/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Mylo LLC	973654	Agent - Casualty	12/17/2019	8/17/2020
Inactive	Mylo LLC	973654	Agent - Property	12/17/2019	8/17/2020