DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Dausman, David Robert	DOIID	566327	NAIC NPN	6399016

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	3/14/2003		8/31/2024
* 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	06/15/2024	08/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	7/21/2016	9/30/2017
Inactive	QBE Insurance Corporation	300515	Agent - Health	3/26/2003	10/9/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Excess Risk Reinsurance, Inc.	567406	Agent - Health	4/7/2003	3/31/2021
Active	Reunion Health Services, Llc	1148948	Agent - Health	8/4/2021
Denied	Starr Wright Insurance Agency , Inc	397651	Agent - Health