DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Atkielski, Roman David	DOIID	1138666	NAIC NPN	15967779

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	6/9/2021		2/28/2026
Active	Non Resident	Agent	Health	6/9/2021		2/28/2026
Active	Non Resident	Agent	Property	6/9/2021		2/28/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	10/6/2021		2/28/2026
* 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	Berkley Casualty Company	300731	Agent - Casualty	3/13/2023
Active	Berkley Casualty Company	300731	Agent - Property	3/13/2023
Active	United States Fire Insurance Company	582240	Agent - Casualty	11/10/2021
Active	United States Fire Insurance Company	582240	Agent - Health	10/15/2021
Active	United States Fire Insurance Company	582240	Agent - Property	11/10/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	ICM Insurance Service LLC	937342	Agent - Casualty	12/1/2021	4/11/2022
Inactive	ICM Insurance Service LLC	937342	Agent - Health	12/1/2021	4/11/2022
Inactive	ICM Insurance Service LLC	937342	Agent - Property	12/1/2021	4/11/2022
Inactive	ICM Insurance Service LLC	937342	Surplus Lines Broker - Not Applicable	12/9/2021	4/11/2022
Active	Jencap Insurance Services Inc.	705614	Agent - Casualty	4/27/2023
Active	Jencap Insurance Services Inc.	705614	Agent - Property	4/27/2023
Active	Jencap Insurance Services Inc.	705614	Surplus Lines Broker - Not Applicable	4/27/2023