DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bellah, Madison R	DOIID	1282578	NAIC NPN	20515129

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	6/28/2023		7/31/2024
Active	Non Resident	Agent	Casualty	6/28/2023		7/31/2024
Active	Non Resident	Surplus Lines Broker	Not Applicable	2/1/2024		7/31/2026
* 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	05/15/2024	07/31/2024

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	7/18/2023
Active	Zurich American Insurance Company	301121	Agent - Property	7/18/2023

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 Northeast Inc	537673	Agent - Casualty	7/27/2023
Active	Willis Towers Watson Northeast Inc	537673	Agent - Property	7/27/2023
Active	Willis Towers Watson Northeast Inc	537673	Surplus Lines Broker - Not Applicable	2/9/2024