DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kaufman, Samuel E	DOIID	1169973	NAIC NPN	18962624

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	11/1/2021		2/28/2026
Active	Non Resident	Agent	Property	11/1/2021		2/28/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	12/7/2023		2/28/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Zurich American Insurance Company	301121	Agent - Casualty	11/5/2021
Active	Zurich American Insurance Company	301121	Agent - Property	11/5/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Willis Towers Watson Midwest, Inc.	534348	Agent - Casualty	11/10/2021
Active	Willis Towers Watson Midwest, Inc.	534348	Agent - Property	11/10/2021
Active	Willis Towers Watson Midwest, Inc.	534348	Surplus Lines Broker - Not Applicable	12/21/2023
Inactive	Willis Towers Watson Northeast Inc	537673	Surplus Lines Broker - Not Applicable	12/16/2023	12/16/2023