DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Peterson, Melissa Ann	DOIID	1278479	NAIC NPN	20109878

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	6/6/2023		1/31/2025
Active	Non Resident	Agent	Property	6/6/2023		1/31/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	7/21/2023		1/31/2025
* 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	11/15/2024	01/31/2025
Surplus Lines Broker	11/15/2024	01/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Zurich American Insurance Company	301121	Agent - Casualty	6/19/2023
Active	Zurich American Insurance Company	301121	Agent - Property	6/19/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Willis Towers Watson Insurance Services West Inc	538729	Agent - Casualty	6/29/2023
Active	Willis Towers Watson Insurance Services West Inc	538729	Agent - Property	6/29/2023
Active	Willis Towers Watson Insurance Services West Inc	538729	Surplus Lines Broker - Not Applicable	8/3/2023