DEPARTMENT OF INSURANCE

Name	Chatham, Thomas W	DOIID	350992	NAIC NPN	331830

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	8/15/2000		10/31/2025
Active	Non Resident	Agent	Casualty	8/15/2000		10/31/2025
Active	Non Resident	Agent	Health	6/20/1995		10/31/2025
Active	Non Resident	Agent	Life	6/20/1995		10/31/2025
Inactive	Non Resident	Agent	Health Maintenance Organization	1/27/1998	3/1/2001
Inactive	Non Resident	Agent	General Lines	8/12/1988	8/15/2000
Active	Non Resident	Surplus Lines Broker	Not Applicable	3/14/2017		10/31/2025

*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	08/15/2025	10/31/2025
Surplus Lines Broker	08/15/2025	10/31/2025

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	Usi Midwest 312 Elm Street, 24th FloorCincinnati, OH 45202
Residence	Not Public Information

Internet Information

Type	Address
Business Email	tom.chatham@usi.com

Phone Information

Type	Phone
Business / Home Office	(513) 852-6444