DEPARTMENT OF INSURANCE

Affiliations

Name	Private Client Select Insurance Services LLC	DOIID	1242047	NAIC NPN	20516454

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	11/13/2022	3/31/2026
Active	Non Resident	Agent	Casualty	11/13/2022	3/31/2026
Active	Non Resident	Independent Adjuster	Property & Casualty	11/21/2022	3/31/2026
Active	Non Resident	Managing General Agent	Not Applicable	1/31/2024	3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	11/13/2022	3/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	AIG Property Casualty Company	300621	Agent - Casualty	1/26/2023
Active	AIG Property Casualty Company	300621	Agent - Property	1/26/2023
Active	American Home Assurance Company	300246	Agent - Casualty	1/26/2023
Active	American Home Assurance Company	300246	Agent - Property	1/26/2023
Active	Commerce and Industry Insurance Company	300881	Agent - Casualty	1/26/2023
Active	Commerce and Industry Insurance Company	300881	Agent - Property	1/26/2023
Active	Granite State Insurance Company	300818	Agent - Casualty	1/26/2023
Active	Granite State Insurance Company	300818	Agent - Property	1/26/2023
Active	Illinois National Insurance Company	301367	Agent - Casualty	1/26/2023
Active	Illinois National Insurance Company	301367	Agent - Property	1/26/2023
Active	Insurance Company of the State of Pennsylvania	300807	Agent - Casualty	1/26/2023
Active	Insurance Company of the State of Pennsylvania	300807	Agent - Property	1/26/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bayram, Marc Anthony	896756	Agent - Casualty	11/13/2022
Active	Bayram, Marc Anthony	896756	Agent - Property	11/13/2022
Inactive	Bazan, Brian C	1207681	Agent - Casualty	2/21/2024	5/23/2024
Inactive	Bazan, Brian C	1207681	Agent - Property	2/21/2024	5/23/2024
Active	Bazan, Brian C	1207681	Surplus Lines Broker - Not Applicable	2/21/2024
Active	Blohm, Frederick George	732753	Independent Adjuster - Property & Casualty	11/21/2022
Inactive	Bradley, Vanessa	654543	Agent - Casualty	2/21/2024	5/14/2024
Inactive	Bradley, Vanessa	654543	Agent - Property	2/21/2024	5/14/2024
Active	Carlisle, Janine V	860419	Agent - Casualty	2/21/2024
Active	Carlisle, Janine V	860419	Agent - Property	2/21/2024
Active	Colon, Gail Allen	831419	Agent - Casualty	11/13/2022
Active	Colon, Gail Allen	831419	Agent - Casualty	1/31/2024
Active	Colon, Gail Allen	831419	Agent - Property	11/13/2022
Active	Colon, Gail Allen	831419	Agent - Property	1/31/2024
Active	Colon, Gail Allen	831419	Surplus Lines Broker - Not Applicable	11/13/2022
Active	Delffs, Patricia Anne	877894	Agent - Casualty	2/21/2024
Active	Delffs, Patricia Anne	877894	Agent - Property	2/21/2024
Active	Eiring, Carla Bisgaard	1180896	Agent - Casualty	2/21/2024
Active	Eiring, Carla Bisgaard	1180896	Agent - Property	2/21/2024
Active	Eiring, Carla Bisgaard	1180896	Surplus Lines Broker - Not Applicable	2/21/2024
Active	Gouwens, Patrick Robert	374260	Independent Adjuster - Property & Casualty	12/13/2023
Denied	Huntley, Guy M	1303047	Agent - Casualty
Denied	Huntley, Guy M	1303047	Agent - Property
Active	Huntley, Guy M	1303047	Surplus Lines Broker - Not Applicable	2/21/2024
Active	Kean, Lana Doucet	873289	Agent - Casualty	2/21/2024
Active	Kean, Lana Doucet	873289	Agent - Property	2/21/2024
Active	Moore, Kelly J	878057	Agent - Casualty	2/21/2024
Active	Moore, Kelly J	878057	Agent - Property	2/21/2024
Active	Weinberger, Sandra Jean	877908	Agent - Casualty	2/21/2024
Active	Weinberger, Sandra Jean	877908	Agent - Property	2/21/2024