DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Carlsen, John M	DOIID	809221	NAIC NPN	5714314

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	5/2/2013	6/30/2021
Inactive	Non Resident	Agent	Property	5/2/2013	6/30/2021
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	5/2/2013	6/30/2021
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	AmWINS Brokerage of the Mid-Atlantic, LLC	551884	Agent - Property
Denied	AmWINS Brokerage of the Mid-Atlantic, LLC	551884	Agent - Casualty