DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Samson, Thomas Wesley	DOIID	1186120	NAIC NPN	20223290

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	2/2/2022		9/30/2024
Active	Non Resident	Agent	Casualty	2/2/2022		9/30/2024
* 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	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Independence American Insurance Company	524747	Agent - Casualty	9/11/2023
Active	Independence American Insurance Company	524747	Agent - Property	9/11/2023
Active	North River Insurance Company (The)	301739	Agent - Casualty	3/8/2022
Active	North River Insurance Company (The)	301739	Agent - Property	3/8/2022
Active	United States Fire Insurance Company	582240	Agent - Casualty	3/8/2022
Active	United States Fire Insurance Company	582240	Agent - Property	3/8/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	PTZ Insurance Agency LTD	695420	Agent - Casualty	3/8/2022
Active	PTZ Insurance Agency LTD	695420	Agent - Property	3/8/2022