DEPARTMENT OF INSURANCE

Name	Black, Andre Leonard	DOIID	907789	NAIC NPN	17338936

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Agent	Property	2/24/2016		11/30/2024
Active	Non Resident	Agent	Casualty	2/24/2016		11/30/2024

*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
Agent	09/15/2024	11/30/2024

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
Residence	Not Public Information
Business / Home Office	1010 Johnson Rd Ste 150 Golden, CO 804016041

Phone Information

Type	Phone
Business / Home Office	(231) 941-7477