DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Hallstrom, David	DOIID	1079819	NAIC NPN	2503741

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	3/30/2020		7/31/2025
Active	Non Resident	Agent	Casualty	3/30/2020		7/31/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	11/28/2020		7/31/2025
* 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	05/15/2025	07/31/2025
Surplus Lines Broker	05/15/2025	07/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Zurich American Insurance Company	301121	Agent - Casualty	4/15/2020	6/13/2022
Inactive	Zurich American Insurance Company	301121	Agent - Property	4/15/2020	6/13/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Towers Watson Midwest, Inc	534348	Agent - Casualty	4/20/2020	1/25/2022
Inactive	Willis Towers Watson Midwest, Inc	534348	Agent - Property	4/20/2020	1/25/2022
Inactive	Willis Towers Watson Midwest, Inc	534348	Surplus Lines Broker - Not Applicable	12/14/2020	1/25/2022