DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kiczuk, Christopher M	DOIID	525832	NAIC NPN	3750478

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	4/12/2012	5/31/2013
Inactive	Non Resident	Agent	Travel	4/12/2012	5/31/2013
Inactive	Non Resident	Agent	Casualty	4/12/2012	5/31/2013
* 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 Family Home Insurance Company	301817	Agent - Casualty	4/26/2012	5/31/2013
Inactive	American Family Home Insurance Company	301817	Agent - Property	4/26/2012	5/31/2013
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	4/26/2012	5/31/2013
Inactive	American Modern Home Insurance Company	300791	Agent - Property	4/26/2012	5/31/2013
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	4/26/2012	5/31/2013
Inactive	American Modern Select Insurance Company	581481	Agent - Property	4/26/2012	5/31/2013
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	4/26/2012	5/31/2013
Inactive	American Southern Home Insurance Company	626276	Agent - Property	4/26/2012	5/31/2013
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	6/16/2012	6/17/2013
Inactive	Bristol West Insurance Company	301655	Agent - Property	6/16/2012	6/17/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/16/2012	6/17/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/16/2012	6/17/2013
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	5/7/2001	7/31/2003
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	5/7/2001	7/31/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Banc Ins Agency Inc	691585	Agent - Casualty	9/4/2012	5/1/2013
Inactive	Banc Ins Agency Inc	691585	Agent - Property	9/4/2012	5/1/2013