DEPARTMENT OF INSURANCE

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.

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