DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Bazan, Brian C	DOIID	1207681	NAIC NPN	8521550

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	5/27/2022		6/30/2025
Active	Non Resident	Agent	Casualty	5/27/2022		6/30/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/27/2022		6/30/2025
* 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	04/15/2025	06/30/2025
Surplus Lines Broker	04/15/2025	06/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	12/14/2022	5/23/2024
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	12/14/2022	5/23/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Private Client Select Insurance Services LLC	1242047	Agent - Casualty	2/21/2024	5/23/2024
Inactive	Private Client Select Insurance Services LLC	1242047	Agent - Property	2/21/2024	5/23/2024
Inactive	Private Client Select Insurance Services LLC	1242047	Surplus Lines Broker - Not Applicable	2/21/2024	12/23/2024
Denied	Risk Specialists Companies Ins Agency Inc	669694	Agent - Casualty
Denied	Risk Specialists Companies Ins Agency Inc	669694	Agent - Property
Inactive	Risk Specialists Companies Ins Agency Inc	669694	Surplus Lines Broker - Not Applicable	6/13/2022	9/24/2024