Individual Information

MICHAEL D WILLIAMS

ST LOUIS PARK, MN 55416-1787

Active

mwilliams@ccisurety.com

05/02/2003

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	174080	05/02/2003	Active	05/02/2003	05/31/2027

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	05/02/2003	Active	05/02/2003
Property	05/02/2003	Active	05/02/2003
Surety	05/02/2003	Inactive	01/01/2020

Company Name	Appointment Type	Status	Active Date
1416
CAPITOL INDEMNITY CORPORATION	Casualty	Active	04/28/2016
1728
Company Name	Appointment Type	Status	Active Date
GREAT MIDWEST INSURANCE COMPANY	Casualty	Active	01/14/2020
	Property	Active	01/14/2020
306
Company Name	Appointment Type	Status	Active Date
HARCO NATIONAL INSURANCE COMPANY	Casualty	Active	05/06/2019
1741
Company Name	Appointment Type	Status	Active Date
HUDSON INSURANCE COMPANY	Casualty	Active	10/16/2013
	Property	Active	10/16/2013
14187
Company Name	Appointment Type	Status	Active Date
LEXINGTON NATIONAL INSURANCE CORPORATION	Casualty	Active	07/28/2021
461
Company Name	Appointment Type	Status	Active Date
NATIONWIDE MUTUAL INSURANCE COMPANY	Casualty	Active	03/22/2020
	Property	Active	03/22/2020
1295
Company Name	Appointment Type	Status	Active Date
PHILADELPHIA INDEMNITY INSURANCE COMPANY	Casualty	Active	11/13/2013
	Property	Active	11/13/2013
1012
Company Name	Appointment Type	Status	Active Date
PLATTE RIVER INSURANCE COMPANY	Casualty	Active	09/26/2017
1054
Company Name	Appointment Type	Status	Active Date
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA	Casualty	Active	05/29/2020
	Property	Active	05/29/2020
692
Company Name	Appointment Type	Status	Active Date
UNITED STATES FIRE INSURANCE COMPANY	Casualty	Active	04/20/2021
	Property	Active	04/20/2021

row(s) 1 - 16 of 16

Organization	Association Type	Type	Beg dte	End dte
CCI SURETY INC	Designated Resp Lic Prdcr	Agency	09/18/2020	-

1 - 1