DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Dubois, Gary	DOIID	871829	NAIC NPN	17202050

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	3/11/2015	8/8/2017
Inactive	Non Resident	Agent	Casualty	3/11/2015	8/8/2017
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	3/11/2015	8/8/2017
* 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	Pioneer Special Risk Insurance Services, Inc	711258	Agent - Property
Denied	Pioneer Special Risk Insurance Services, Inc	711258	Agent - Casualty
Inactive	Pioneer Special Risk Insurance Services, Inc	711258	Surplus Lines Broker - Not Applicable	5/25/2015	11/10/2016