DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Excess Risk Underwriters Inc	DOIID	514314	NAIC NPN	1048387

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	10/20/2000		3/31/2026
Active	Non Resident	Agent	Health	3/28/2007		3/31/2026
Active	Non Resident	Agent	Life	3/28/2007		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
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	4/17/2007	7/18/2016
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	4/17/2007	7/18/2016
Active	Symetra Life Insurance Company	301691	Agent - Health	4/1/2007
Active	Symetra Life Insurance Company	301691	Agent - Life	4/1/2007

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Cullen, Martin Steven	514315	Administrator - Not Applicable	10/20/2000
Active	Cullen, Martin Steven	514315	Agent - Health	3/5/2024
Active	Cullen, Martin Steven	514315	Agent - Life	3/5/2024
Inactive	Rassiga, Frank Stephen	383508	Agent - Health	6/21/2007	2/9/2024
Inactive	Rassiga, Frank Stephen	383508	Agent - Life	6/21/2007	2/9/2024