DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Excess Risk Reinsurance, Inc.	DOIID	567406	NAIC NPN	7638948

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/7/2003	3/31/2021
* 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	Companion Life Insurance Company	300191	Agent - Health	6/26/2013	10/23/2013
Inactive	QBE Insurance Corporation	300515	Agent - Health	7/22/2003	10/7/2015
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	11/15/2004	1/11/2010

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Dausman, David Robert	566327	Agent - Health	4/7/2003	3/31/2021