DEPARTMENT OF INSURANCE

Name	Self Insured Services Company, LLC	DOIID	397375	NAIC NPN	7220493

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Administrator	Not Applicable	4/19/2010		3/31/2025

*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	01/15/2025	03/31/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Mailing	800 Main Street Dubuque, IA 52001
Business / Home Office	800 Main Street Dubuque, IA 52001

Internet Information

Type	Address
Business Email	kara.murray@cb-sisco.com
Internet	www.cb-sisco.com

Phone Information

Type	Phone
Business / Home Office	(563) 587-5204