DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Gullickson, Matthew	DOIID	931681	NAIC NPN	16766589

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	10/3/2016	6/30/2020
Inactive	Non Resident	Agent	Property	10/3/2016	6/30/2020
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	1/3/2017	5/3/2019
* 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	Fireman's Fund Insurance Company	301423	Agent - Casualty	10/11/2016	6/30/2020
Inactive	Fireman's Fund Insurance Company	301423	Agent - Property	10/11/2016	6/30/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Property	10/11/2016	6/30/2020
Inactive	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Casualty	10/11/2016	6/30/2020
Inactive	Arthur J. Gallagher Risk Management Services, LLC	539806	Surplus Lines Broker - Not Applicable	1/11/2017	5/3/2019