DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Larsen, Merwyn R	DOIID	740773	NAIC NPN	289973

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	10/22/2010	12/9/2013
Inactive	Non Resident	Agent	Property	10/22/2010	12/9/2013
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	4/1/2011	12/9/2013
* 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	Capitol Indemnity Corporation	301030	Agent - Casualty	2/13/2013	12/9/2013
Inactive	Capitol Indemnity Corporation	301030	Agent - Property	2/13/2013	12/9/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Erickson Larsen Inc	807265	Agent - Casualty	4/5/2013	12/9/2013
Inactive	Erickson Larsen Inc	807265	Agent - Property	4/5/2013	12/9/2013
Inactive	Stonebridge Underwriters Inc	754455	Agent - Casualty	5/16/2011	12/9/2013
Inactive	Stonebridge Underwriters Inc	754455	Agent - Property	5/16/2011	12/9/2013
Inactive	Stonebridge Underwriters Inc	754455	Surplus Lines Broker - Not Applicable	5/16/2011	12/9/2013