DEPARTMENT OF INSURANCE

Affiliations

Name	Coburn, Samuel A	DOIID	582512	NAIC NPN	2295548

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	12/30/2003	8/31/2025
Active	Non Resident	Agent	Casualty	12/30/2003	8/31/2025
Active	Non Resident	Agent	Health	12/30/2003	8/31/2025
Active	Non Resident	Agent	Life	12/30/2003	8/31/2025
* 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	06/15/2025	08/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE American Insurance Company	300625	Agent - Casualty	11/5/2004
Active	ACE American Insurance Company	300625	Agent - Property	11/5/2004
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	11/10/2006
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Property	11/10/2006
Active	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	4/20/2005
Active	ACE Property and Casualty Insurance Company	300520	Agent - Property	4/20/2005
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	1/23/2012	12/9/2013
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	1/23/2012	12/9/2013
Active	Bankers Standard Insurance Company	301620	Agent - Casualty	11/10/2006
Active	Bankers Standard Insurance Company	301620	Agent - Property	11/10/2006
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	1/23/2012	3/18/2014
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	1/23/2012	3/18/2014
Inactive	Farmington Casualty Company	301137	Agent - Casualty	1/23/2012	12/9/2013
Inactive	Farmington Casualty Company	301137	Agent - Property	1/23/2012	12/9/2013
Inactive	Federal Insurance Company	301144	Agent - Casualty	8/17/2004	12/18/2008
Inactive	Federal Insurance Company	301144	Agent - Property	8/17/2004	12/18/2008
Active	Hartford Underwriters Insurance Company	301064	Agent - Casualty	9/14/2020
Active	Hartford Underwriters Insurance Company	301064	Agent - Property	9/14/2020
Active	Indemnity Insurance Company of North America	301760	Agent - Casualty	11/5/2004
Active	Indemnity Insurance Company of North America	301760	Agent - Property	11/5/2004
Active	Metropolitan Life Insurance Company	301948	Agent - Health	8/23/2017
Active	Metropolitan Life Insurance Company	301948	Agent - Life	8/23/2017
Active	Pacific Employers Insurance Company	301753	Agent - Casualty	11/10/2006
Active	Pacific Employers Insurance Company	301753	Agent - Property	11/10/2006
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Casualty	1/23/2012	3/18/2014
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Property	1/23/2012	3/18/2014
Inactive	St. Paul Guardian Insurance Company	301372	Agent - Casualty	1/23/2012	12/9/2013
Inactive	St. Paul Guardian Insurance Company	301372	Agent - Property	1/23/2012	12/9/2013
Inactive	St. Paul Mercury Insurance Company	300783	Agent - Casualty	1/23/2012	12/9/2013
Inactive	St. Paul Mercury Insurance Company	300783	Agent - Property	1/23/2012	12/9/2013
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	1/23/2012	12/9/2013
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	1/23/2012	12/9/2013
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	1/23/2012	12/9/2013
Inactive	The Phoenix Insurance Company	301502	Agent - Property	1/23/2012	12/9/2013
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	1/23/2012	12/9/2013
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	1/23/2012	12/9/2013
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	1/23/2012	3/18/2014
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	1/23/2012	3/18/2014
Inactive	Travelers Commercial Insurance Company	301506	Agent - Casualty	1/23/2012	12/9/2013
Inactive	Travelers Commercial Insurance Company	301506	Agent - Property	1/23/2012	12/9/2013
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Casualty	1/23/2012	3/18/2014
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Property	1/23/2012	3/18/2014
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	1/23/2012	3/18/2014
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	1/23/2012	3/18/2014
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	1/23/2012	12/9/2013
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	1/23/2012	12/9/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	1/23/2012	3/18/2014
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	1/23/2012	3/18/2014
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	1/23/2012	3/18/2014
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	1/23/2012	3/18/2014
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	8/12/2004	1/11/2006
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	8/12/2004	1/11/2006
Inactive	Westchester Fire Insurance Company	301414	Agent - Casualty	11/5/2004	1/1/2011
Active	Westchester Fire Insurance Company	300990	Agent - Casualty	1/1/2011
Inactive	Westchester Fire Insurance Company	301414	Agent - Property	11/5/2004	1/1/2011
Active	Westchester Fire Insurance Company	300990	Agent - Property	1/1/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	8/23/2017	10/9/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	8/23/2017	10/9/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Property	7/20/2017	10/9/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Casualty	7/20/2017	10/9/2019
Active	Usi Insurance Services LLC	669260	Agent - Life	1/8/2019
Active	Usi Insurance Services LLC	669260	Agent - Health	1/8/2019
Active	Usi Insurance Services LLC	669260	Agent - Property	1/8/2019
Active	Usi Insurance Services LLC	669260	Agent - Casualty	1/8/2019
Inactive	Willis Of New Jersey Inc	595076	Agent - Life	9/7/2004	1/11/2006
Inactive	Willis Of New Jersey Inc	595076	Agent - Health	9/7/2004	1/11/2006
Inactive	Willis Of New Jersey Inc	595076	Agent - Property	9/7/2004	1/26/2007
Inactive	Willis Of New Jersey Inc	595076	Agent - Casualty	9/7/2004	1/26/2007