DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Siegel, Christopher	DOIID	1143220	NAIC NPN	4602934

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	7/2/2021		8/31/2026
Active	Non Resident	Agent	Property	7/2/2021		8/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	7/13/2021		8/31/2026
* 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	06/15/2024	08/31/2024	06/12/2024	06/12/2024	Yes
Surplus Lines Broker	06/15/2024	08/31/2024	06/12/2024	06/12/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Atain Insurance Company	681449	Agent - Casualty	11/1/2022
Active	Atain Insurance Company	681449	Agent - Property	11/1/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Burns & Wilcox Ltd	525929	Agent - Casualty	11/1/2022
Active	Burns & Wilcox Ltd	525929	Agent - Property	11/1/2022
Active	Burns & Wilcox Ltd	525929	Surplus Lines Broker - Not Applicable	9/13/2022