DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	De La Casa, Gomez	DOIID	595904	NAIC NPN	6078188

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/21/2004		9/30/2025
Active	Non Resident	Agent	Life	9/21/2004		9/30/2025
* 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	Berkshire Life Insurance Company of America	300983	Agent - Health	2/17/2005	10/12/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	2/17/2005	10/12/2020
Active	Guardian Life Insurance Company of America	301316	Agent - Health	2/17/2005
Active	Guardian Life Insurance Company of America	301316	Agent - Life	2/17/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Mesirow Ins Services Inc	510824	Agent - Life	2/17/2005
Active	Mesirow Ins Services Inc	510824	Agent - Health	2/17/2005