DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Brentwood Reinsurance Intermediaries Inc	DOIID	778833	NAIC NPN	9582287

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	4/5/2012		3/31/2026
Active	Non Resident	Agent	Casualty	4/5/2012		3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	4/1/2014		3/31/2026
* 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	01/15/2026	03/31/2026
Surplus Lines Broker	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arch Insurance Company	300688	Agent - Casualty	4/11/2013
Active	Arch Insurance Company	300688	Agent - Property	4/11/2013
Inactive	Gray Insurance Company (The)	301532	Agent - Casualty	5/18/2017	12/19/2023
Inactive	Gray Insurance Company (The)	301532	Agent - Property	5/18/2017	12/19/2023
Active	Midwest Employers Casualty Company	300124	Agent - Casualty	12/7/2012
Active	Midwest Employers Casualty Company	300124	Agent - Property	12/7/2012

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Fawcett, Keith	383998	Agent - Casualty	4/9/2012
Active	Fawcett, Keith	383998	Agent - Property	4/9/2012
Inactive	Hammer, Richard Douglas	364830	Agent - Casualty	11/1/2013	11/16/2022
Inactive	Hammer, Richard Douglas	364830	Agent - Property	11/1/2013	11/16/2022
Active	Peterson, Heather N	1142920	Agent - Casualty	7/29/2021
Active	Peterson, Heather N	1142920	Agent - Property	7/29/2021
Inactive	Raley, Lisa Renee	551701	Agent - Casualty	11/1/2013	12/7/2022
Inactive	Raley, Lisa Renee	551701	Agent - Property	11/1/2013	12/7/2022
Active	Wilson, Dawn	507147	Agent - Casualty	4/5/2012
Active	Wilson, Dawn	507147	Agent - Property	4/5/2012
Active	Wilson, Dawn	507147	Surplus Lines Broker - Not Applicable	4/1/2014