DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fusion Specialty Americas Insurance Services Llc	DOIID	1083560	NAIC NPN	19487260

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	5/11/2020		3/31/2026
Active	Non Resident	Agent	Property	5/11/2020		3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	8/27/2021		3/31/2026
* 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
Active	Imperium Insurance Company	300804	Agent - Casualty	2/27/2023
Active	Imperium Insurance Company	300804	Agent - Property	2/27/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Hughes, Forest Ingram	876593	Agent - Casualty	5/11/2020	2/7/2023
Inactive	Hughes, Forest Ingram	876593	Agent - Property	5/11/2020	2/7/2023
Inactive	Hughes, Forest Ingram	876593	Surplus Lines Broker - Not Applicable	8/27/2021	2/7/2023
Active	Mora, Michael Alan	1212985	Agent - Casualty	2/27/2023
Active	Mora, Michael Alan	1212985	Agent - Property	2/27/2023
Active	Mora, Michael Alan	1212985	Surplus Lines Broker - Not Applicable	10/11/2022
Denied	Stortzum, Nathan	1198744	Agent - Casualty
Denied	Stortzum, Nathan	1198744	Agent - Property
Inactive	Stortzum, Nathan	1198744	Surplus Lines Broker - Not Applicable	2/7/2023	2/27/2023