DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Gross, David Michael	DOIID	1277550	NAIC NPN	4592557

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	5/31/2023		8/31/2026
Active	Non Resident	Agent	Casualty	5/31/2023		8/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	6/6/2023		8/31/2026
* 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	06/15/2024	08/31/2024	06/18/2024	06/18/2024	Yes
Surplus Lines Broker	06/15/2024	08/31/2024	06/18/2024	06/18/2024	Yes

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Burns & Wilcox Ltd	525929	Agent - Casualty
Denied	Burns & Wilcox Ltd	525929	Agent - Property
Active	Burns & Wilcox Ltd	525929	Surplus Lines Broker - Not Applicable	7/28/2023