DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ursus Insurance Services Inc.	DOIID	1133618	NAIC NPN	19882283

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	5/7/2021		3/31/2025
Active	Non Resident	Agent	Casualty	5/7/2021		3/31/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/18/2021		3/31/2025
* 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	01/15/2025	03/31/2025
Surplus Lines Broker	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	State National Insurance Company, Inc.	300888	Agent - Casualty	11/8/2023
Active	State National Insurance Company, Inc.	300888	Agent - Property	11/8/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Taylor, Zachary	1119921	Agent - Casualty	11/8/2023
Active	Taylor, Zachary	1119921	Agent - Property	11/8/2023
Active	Taylor, Zachary	1119921	Surplus Lines Broker - Not Applicable	10/16/2023
Inactive	Trimble, Nathan	1131040	Agent - Casualty	5/7/2021	10/16/2023
Inactive	Trimble, Nathan	1131040	Agent - Property	5/7/2021	10/16/2023
Inactive	Trimble, Nathan	1131040	Surplus Lines Broker - Not Applicable	5/18/2021	10/16/2023