DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bongi, Thomas Michael	DOIID	1228088	NAIC NPN	19013612

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	9/7/2022		5/31/2026
Active	Non Resident	Agent	Property	9/7/2022		5/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	9/7/2022		5/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Convex North America Insurance Services LLC	1154417	Agent - Casualty
Denied	Convex North America Insurance Services LLC	1154417	Agent - Property
Active	Convex North America Insurance Services LLC	1154417	Surplus Lines Broker - Not Applicable	10/14/2022