DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Dioses, Marisol	DOIID	868863	NAIC NPN	17441410

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	3/3/2015		7/31/2026
Active	Non Resident	Agent	Life	2/12/2015		7/31/2026
Active	Non Resident	Agent	Health	2/12/2015		7/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Administrator	05/15/2024	07/31/2024	05/16/2024	05/16/2024	Yes
Agent	05/15/2024	07/31/2024	05/16/2024	05/16/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Metropolitan Life Insurance Company	301948	Agent - Health	6/24/2015
Active	Metropolitan Life Insurance Company	301948	Agent - Life	6/24/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Life	6/16/2023
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Health	6/16/2023
Active	Gallagher Affinity Insurance Services, Inc.	397758	Agent - Life	4/9/2024
Active	Gallagher Affinity Insurance Services, Inc.	397758	Agent - Health	4/9/2024
Inactive	Physicians Planning Service Corporation Of Connecticut	398049	Agent - Life	7/6/2015	4/1/2024
Inactive	Physicians Planning Service Corporation Of Connecticut	398049	Agent - Health	7/6/2015	4/1/2024
Active	Physicians Planning Service Corporation Of Connecticut	398049	Administrator - Not Applicable	11/19/2015