DEPARTMENT OF INSURANCE

Name	Carson, Samuel	DOIID	1049032	NAIC NPN	16865710

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	7/29/2019	3/31/2026
Active	Non Resident	Agent	Casualty	7/29/2019	3/31/2026
Active	Non Resident	Agent	Property	7/29/2019	3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	3/23/2020	3/31/2026

*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	111 S Wacker Dr Ste 3900 Chicago, IL 606064447
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(248) 702-1024