DEPARTMENT OF INSURANCE

Name	Bazan, Brian C	DOIID	1207681	NAIC NPN	8521550

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	5/27/2022	6/30/2025
Active	Non Resident	Agent	Casualty	5/27/2022	6/30/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/27/2022	6/30/2025

*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	500 West Madison Chicago, IL 60661
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(312) 720-7417