DEPARTMENT OF INSURANCE

Name	Mantz, Douglas R	DOIID	535402	NAIC NPN	964788

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	12/10/2018	10/31/2024
Active	Non Resident	Agent	Casualty	6/17/2019	10/31/2024
Active	Non Resident	Agent	Property	6/17/2019	10/31/2024
Active	Non Resident	Agent	Life	8/17/2001	10/31/2024
Active	Non Resident	Agent	Health	8/17/2001	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
Administrator	08/15/2024	10/31/2024
Agent	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	30 Waterside Drive Farmington, CT 060340527
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(860) 674-0501