DEPARTMENT OF INSURANCE

Name	Chicoski Iii, Edward Joseph	DOIID	716922	NAIC NPN	5439842

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	11/14/2017	12/31/2021
Inactive	Non Resident	Agent	Casualty	11/14/2017	12/31/2021
Inactive	Non Resident	Agent	Travel	10/29/2009	12/31/2015
Inactive	Non Resident	Agent	Health	10/29/2009	12/31/2015
Inactive	Non Resident	Agent	Life	10/29/2009	12/31/2015
Inactive	Non Resident	Agent	Limited Line Credit	10/29/2009	12/31/2015

*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	Lakeshore Benefit Group Insurance Brokerage, Llc 301 Albany TpkeCanton, CT 060192528
Residence	Not Public Information

Internet Information

Type	Address
Business Email	e.chicoski@lakeshorebenefitgroup.com

Phone Information

Type	Phone
Business / Home Office	(860) 738-9512