DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bergen, William Thomas	DOIID	767236	NAIC NPN	16426978

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	10/26/2011	8/31/2014
Inactive	Non Resident	Agent	Health	10/21/2011	8/31/2014
* 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	MetLife Investors USA Insurance Company	300845	Agent - Life	4/2/2012	2/7/2013
Inactive	Starr Indemnity and Liability Company	301685	Agent - Health	3/8/2012	1/23/2014
Inactive	Time Insurance Company	300683	Agent - Health	10/27/2011	7/2/2012
Inactive	Time Insurance Company	300683	Agent - Life	10/27/2011	7/2/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	11/4/2011	6/29/2012
Inactive	TZ Insurance Solutions LLC	727470	Agent - Life	11/4/2011	6/29/2012