DEPARTMENT OF INSURANCE

Affiliations

Name	Conifer Insurance Services, LLC	DOIID	829297	NAIC NPN	16646373

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	5/23/2016	3/31/2027
Active	Non Resident	Agent	Casualty	5/23/2016	3/31/2027
Active	Non Resident	Surplus Lines Broker	Not Applicable	12/10/2013	3/31/2027
* 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	01/15/2027	03/31/2027
Surplus Lines Broker	01/15/2027	03/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	3/15/2017
Active	First Liberty Insurance Corporation (The)	301060	Agent - Property	3/15/2017
Inactive	LM General Insurance Company	300133	Agent - Casualty	3/15/2017	9/26/2024
Inactive	LM General Insurance Company	300133	Agent - Property	3/15/2017	9/26/2024
Active	LM Insurance Corporation	301061	Agent - Casualty	3/15/2017
Active	LM Insurance Corporation	301061	Agent - Property	3/15/2017
Active	Liberty Insurance Corporation	300444	Agent - Casualty	3/15/2017
Active	Liberty Insurance Corporation	300444	Agent - Property	3/15/2017
Active	Liberty Insurance Underwriters Inc.	301391	Agent - Casualty	4/30/2019
Active	Liberty Insurance Underwriters Inc.	301391	Agent - Property	4/30/2019
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	3/15/2017
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Property	3/15/2017
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	3/15/2017
Active	Liberty Mutual Insurance Company	301159	Agent - Property	3/15/2017
Inactive	Philadelphia Indemnity Insurance Company	301221	Agent - Casualty	8/4/2021	6/14/2022
Inactive	Philadelphia Indemnity Insurance Company	301221	Agent - Property	8/4/2021	6/14/2022
Inactive	Sagamore Insurance Company	300942	Agent - Property	5/25/2016	2/19/2021
Inactive	Seneca Insurance Company Inc.	301762	Agent - Casualty	5/28/2020	1/13/2022
Active	StarStone National Insurance Company	300812	Agent - Casualty	6/10/2025
Active	StarStone National Insurance Company	300812	Agent - Property	6/10/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	Petcoff, Nicholas James	749880	Agent - Casualty	5/23/2016
Active	Petcoff, Nicholas James	749880	Agent - Property	5/23/2016
Active	Petcoff, Nicholas James	749880	Surplus Lines Broker - Not Applicable	12/10/2013