DEPARTMENT OF INSURANCE

Name	Bergen, William Thomas	DOIID	767236	NAIC NPN	16426978

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Life	10/26/2011	8/31/2014
Inactive	Non Resident	Agent	Health	10/21/2011	8/31/2014

*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	12901 Mcgregor Blvd Suite 1aFort Myers, FL 33919
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(239) 267-8829