DEPARTMENT OF INSURANCE

Name	Potash, Andrew W	DOIID	973472	NAIC NPN	315872

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	10/19/2017	10/31/2024
Active	Non Resident	Agent	Casualty	10/19/2017	10/31/2024
Active	Non Resident	Surplus Lines Broker	Not Applicable	1/18/2019	10/31/2024

*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
Agent	08/15/2024	10/31/2024
Surplus Lines Broker	08/15/2024	10/31/2024

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	1180 Avenue Of The Americas 16th Floor New York, NY 10036
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(212) 297-3104