DEPARTMENT OF INSURANCE

Name	Waller, Kimberly Lynne	DOIID	591141	NAIC NPN	1326154

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	6/21/2004	12/3/2021
Inactive	Non Resident	Agent	Casualty	6/21/2004	12/3/2021
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	6/21/2004	12/3/2021

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	11 Delburne Dr Davis, IL 610199540
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(312) 662-1360