DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Belzer, Donn William	DOIID	611008	NAIC NPN	1899815

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	6/27/2005	2/9/2017
Inactive	Non Resident	Agent	Property	6/27/2005	2/9/2017
Denied	Non Resident	Class type not selected (Individual)	Line of Authority not selected
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	1/19/2006	2/9/2017
* 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	AXA XL Insurance Company Americas	300979	Agent - Casualty	8/1/2010	2/9/2017
Inactive	AXA XL Insurance Company Americas	300979	Agent - Property	8/1/2010	2/9/2017
Inactive	Clarendon National Insurance Company	300843	Agent - Casualty	11/16/2005	7/20/2007
Inactive	Clarendon National Insurance Company	300843	Agent - Property	11/16/2005	7/20/2007
Inactive	Praetorian Insurance Company	301021	Agent - Casualty	1/25/2006	7/23/2007
Inactive	Praetorian Insurance Company	301021	Agent - Property	1/25/2006	7/23/2007

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Catlin Insurance Services, Inc.	662152	Agent - Casualty	8/13/2010	9/23/2016
Inactive	Catlin Insurance Services, Inc.	662152	Agent - Property	8/13/2010	9/23/2016
Inactive	Catlin Insurance Services, Inc.	662152	Surplus Lines Broker - Not Applicable	6/23/2010	2/9/2017
Inactive	Guild Insurance Agency, Inc.	610492	Agent - Casualty	1/11/2006	7/23/2007
Inactive	Guild Insurance Agency, Inc.	610492	Agent - Property	1/11/2006	7/23/2007