DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Convex North America Insurance Services LLC	DOIID	1154417	NAIC NPN	20031631

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	8/26/2021		3/31/2025
Active	Non Resident	Agent	Property	8/26/2021		3/31/2025
Pending	Non Resident	Independent Adjuster	Property & Casualty
Active	Non Resident	Surplus Lines Broker	Not Applicable	8/26/2021		3/31/2025
* 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	01/15/2025	03/31/2025
Surplus Lines Broker	01/15/2025	03/31/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Bongi, Thomas Michael	1228088	Agent - Casualty
Denied	Bongi, Thomas Michael	1228088	Agent - Property
Active	Bongi, Thomas Michael	1228088	Surplus Lines Broker - Not Applicable	10/14/2022
Active	Chauvin, William Pierre	707831	Agent - Casualty	8/26/2021
Active	Chauvin, William Pierre	707831	Agent - Property	8/26/2021
Active	Chauvin, William Pierre	707831	Surplus Lines Broker - Not Applicable	8/26/2021