DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Theisen, Bethany R	DOIID	1338810	NAIC NPN	8726210

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	5/6/2024		3/31/2026
Active	Non Resident	Agent	Property	5/6/2024		3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	6/10/2024		3/31/2026
* 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	01/15/2026	03/31/2026
Surplus Lines Broker	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Guarantee and Liability Insurance Company	301216	Agent - Casualty	5/23/2024
Active	American Guarantee and Liability Insurance Company	301216	Agent - Property	5/23/2024
Active	American Zurich Insurance Company	300592	Agent - Casualty	5/23/2024
Active	American Zurich Insurance Company	300592	Agent - Property	5/23/2024
Active	Zurich American Insurance Company	301121	Agent - Casualty	5/23/2024
Active	Zurich American Insurance Company	301121	Agent - Property	5/23/2024
Active	Zurich American Insurance Company of Illinois	301805	Agent - Casualty	5/23/2024
Active	Zurich American Insurance Company of Illinois	301805	Agent - Property	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
Active	Willis Towers Watson Midwest, Inc	534348	Agent - Casualty	5/28/2024
Active	Willis Towers Watson Midwest, Inc	534348	Agent - Property	5/28/2024
Active	Willis Towers Watson Midwest, Inc	534348	Surplus Lines Broker - Not Applicable	6/18/2024