DEPARTMENT OF INSURANCE

Affiliations

Name	Safehold Special Risk, Inc	DOIID	658217	NAIC NPN	9142974

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	6/26/2009	3/31/2027
Active	Non Resident	Agent	Health	6/26/2009	3/31/2027
Active	Non Resident	Agent	Property	6/20/2007	3/31/2027
Active	Non Resident	Agent	Casualty	6/20/2007	3/31/2027
Active	Non Resident	Independent Adjuster	Property & Casualty	6/8/2011	3/31/2027
Active	Non Resident	Independent Adjuster	Workers' Compensation	6/8/2011	3/31/2027
Active	Non Resident	Surplus Lines Broker	Not Applicable	4/3/2008	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	01/15/2025	03/31/2025	01/02/2025	01/02/2025	Yes
Independent Adjuster	01/15/2025	03/31/2025	01/02/2025	01/02/2025	Yes
Surplus Lines Broker	01/15/2025	03/31/2025	01/02/2025	01/02/2025	Yes

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	6/30/2014
Active	ACE American Insurance Company	300625	Agent - Health	9/20/2009
Active	ACE American Insurance Company	300625	Agent - Property	6/30/2014
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	6/30/2014
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Property	6/30/2014
Active	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	6/30/2014
Active	ACE Property and Casualty Insurance Company	300520	Agent - Property	6/30/2014
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Casualty	6/28/2018
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Property	6/28/2018
Active	AmTrust Insurance Company	300179	Agent - Casualty	9/20/2017
Active	AmTrust Insurance Company	300179	Agent - Property	9/20/2017
Inactive	American Alternative Insurance Corporation	301697	Agent - Casualty	1/22/2014	10/31/2016
Inactive	American Alternative Insurance Corporation	301697	Agent - Property	1/22/2014	10/31/2016
Inactive	American Bankers Insurance Company of Florida	300360	Agent - Casualty	3/4/2014	10/9/2015
Inactive	American Bankers Insurance Company of Florida	300360	Agent - Property	3/4/2014	10/9/2015
Inactive	American Family Home Insurance Company	301817	Agent - Casualty	1/22/2014	6/12/2015
Inactive	American Family Home Insurance Company	301817	Agent - Property	1/22/2014	6/12/2015
Active	American Guarantee and Liability Insurance Company	301216	Agent - Casualty	2/24/2010
Active	American Guarantee and Liability Insurance Company	301216	Agent - Property	2/24/2010
Active	American Interstate Insurance Company	301092	Agent - Casualty	11/8/2012
Active	American Interstate Insurance Company	301092	Agent - Property	11/8/2012
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	8/19/2014	6/12/2015
Inactive	American Modern Home Insurance Company	300791	Agent - Property	8/19/2014	6/12/2015
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	8/19/2014	6/12/2015
Inactive	American Modern Select Insurance Company	581481	Agent - Property	8/19/2014	6/12/2015
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	1/22/2014	6/12/2015
Inactive	American Southern Home Insurance Company	626276	Agent - Property	1/22/2014	6/12/2015
Active	American Zurich Insurance Company	300592	Agent - Casualty	6/11/2008
Active	American Zurich Insurance Company	300592	Agent - Property	6/11/2008
Active	Arch Insurance Company	300688	Agent - Casualty	3/30/2010
Active	Arch Insurance Company	300688	Agent - Property	3/30/2010
Inactive	Assurance Company of America	300432	Agent - Casualty	6/11/2008	12/17/2014
Inactive	Assurance Company of America	300432	Agent - Property	6/11/2008	12/17/2014
Active	Bankers Standard Insurance Company	301620	Agent - Casualty	6/30/2014
Active	Bankers Standard Insurance Company	301620	Agent - Property	6/30/2014
Active	Berkley Life and Health Insurance Company	301421	Agent - Health	8/8/2018
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	10/21/2010	12/9/2013
Inactive	Employers Assurance Company	300120	Agent - Casualty	3/31/2022	1/3/2024
Inactive	Employers Compensation Insurance Company	797885	Agent - Casualty	3/31/2022	1/3/2024
Inactive	Employers Preferred Insurance Company	520656	Agent - Casualty	3/31/2022	1/3/2024
Inactive	Everest Denali Insurance Company	941054	Agent - Casualty	12/25/2020	1/30/2025
Inactive	Everest Denali Insurance Company	941054	Agent - Property	12/25/2020	1/30/2025
Inactive	Everest National Insurance Company	301319	Agent - Casualty	12/25/2020	1/30/2025
Inactive	Everest National Insurance Company	301319	Agent - Property	12/25/2020	1/30/2025
Inactive	Everest Premier Insurance Company	941053	Agent - Casualty	8/3/2021	1/30/2025
Inactive	Everest Premier Insurance Company	941053	Agent - Property	8/3/2021	1/30/2025
Active	Executive Risk Indemnity Inc.	301510	Agent - Casualty	5/6/2024
Active	Executive Risk Indemnity Inc.	301510	Agent - Property	5/6/2024
Inactive	Farmington Casualty Company	301137	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Farmington Casualty Company	301137	Agent - Property	10/21/2010	12/9/2013
Active	Federal Insurance Company	301144	Agent - Casualty	5/6/2024
Active	Federal Insurance Company	301144	Agent - Health	5/6/2024
Active	Federal Insurance Company	301144	Agent - Property	5/6/2024
Active	Granite State Insurance Company	300818	Agent - Casualty	9/25/2014
Active	Granite State Insurance Company	300818	Agent - Property	9/25/2014
Active	Great American Alliance Insurance Company	301247	Agent - Casualty	6/19/2009
Active	Great American Alliance Insurance Company	301247	Agent - Property	6/19/2009
Active	Great American Assurance Company	300327	Agent - Casualty	6/19/2009
Active	Great American Assurance Company	300327	Agent - Property	6/19/2009
Active	Great American Insurance Company	301586	Agent - Casualty	6/19/2009
Active	Great American Insurance Company	301586	Agent - Health	10/19/2017
Active	Great American Insurance Company	301586	Agent - Property	6/19/2009
Active	Great American Insurance Company of New York	301897	Agent - Casualty	6/19/2009
Active	Great American Insurance Company of New York	301897	Agent - Property	6/19/2009
Active	Great American Security Insurance Company	301228	Agent - Casualty	9/10/2010
Active	Great American Security Insurance Company	301228	Agent - Property	9/10/2010
Active	Hanover Insurance Company (The)	300508	Agent - Casualty	6/28/2018
Active	Hanover Insurance Company (The)	300508	Agent - Property	6/28/2018
Inactive	Harleysville Mutual Insurance Company	301393	Agent - Casualty	4/13/2009	9/29/2011
Inactive	Harleysville Mutual Insurance Company	301393	Agent - Property	4/13/2009	9/29/2011
Active	Hartford Accident and Indemnity Company	301917	Agent - Casualty	10/11/2022
Active	Hartford Accident and Indemnity Company	301917	Agent - Property	10/11/2022
Active	Hiscox Insurance Company Inc.	300894	Agent - Casualty	2/5/2014
Active	Hiscox Insurance Company Inc.	300894	Agent - Property	2/5/2014
Active	Illinois National Insurance Company	301367	Agent - Casualty	9/25/2014
Active	Illinois National Insurance Company	301367	Agent - Property	9/26/2014
Active	Indemnity Insurance Company of North America	301760	Agent - Casualty	6/30/2014
Active	Indemnity Insurance Company of North America	301760	Agent - Property	6/30/2014
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	11/14/2011
Active	Manufacturers Alliance Insurance Company	519940	Agent - Casualty	11/29/2016
Active	Manufacturers Alliance Insurance Company	519940	Agent - Property	11/29/2016
Active	Markel American Insurance Company	300377	Agent - Casualty	5/28/2015
Active	Markel American Insurance Company	300377	Agent - Property	5/28/2015
Inactive	Maryland Casualty Company	301719	Agent - Casualty	6/11/2008	12/17/2014
Inactive	Maryland Casualty Company	301719	Agent - Property	6/11/2008	12/17/2014
Active	Milford Casualty Insurance Company	301460	Agent - Casualty	9/20/2017
Active	Milford Casualty Insurance Company	301460	Agent - Property	9/20/2017
Active	NOVA Casualty Company	622806	Agent - Casualty	4/30/2010
Active	NOVA Casualty Company	622806	Agent - Property	4/30/2010
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	12/1/2015
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	12/1/2015
Active	New Hampshire Insurance Company	301670	Agent - Casualty	9/25/2014
Active	New Hampshire Insurance Company	301670	Agent - Property	9/25/2014
Inactive	New York Marine and General Insurance Company	301932	Agent - Casualty	10/17/2016	1/4/2023
Inactive	New York Marine and General Insurance Company	301932	Agent - Property	10/17/2016	1/4/2023
Inactive	Northern Insurance Company of New York	301317	Agent - Casualty	6/11/2008	12/17/2014
Inactive	Northern Insurance Company of New York	301317	Agent - Property	6/11/2008	12/17/2014
Active	Pacific Employers Insurance Company	301753	Agent - Casualty	6/30/2014
Active	Pacific Employers Insurance Company	301753	Agent - Property	6/30/2014
Inactive	Park National Insurance Company	692514	Agent - Casualty	9/20/2017	3/9/2025
Inactive	Park National Insurance Company	692514	Agent - Property	9/20/2017	3/9/2025
Active	Pennsylvania Manufacturers Association Insurance Company	300228	Agent - Casualty	11/29/2016
Active	Pennsylvania Manufacturers Association Insurance Company	300228	Agent - Property	11/29/2016
Active	Pennsylvania Manufacturers Indemnity Company	519939	Agent - Casualty	11/29/2016
Active	Pennsylvania Manufacturers Indemnity Company	519939	Agent - Property	11/29/2016
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Casualty	3/25/2019
Active	Philadelphia Indemnity Insurance Company	301221	Agent - Property	3/25/2019
Inactive	RLI Insurance Company	301217	Agent - Casualty	8/26/2022	9/19/2023
Inactive	RLI Insurance Company	301217	Agent - Property	8/26/2022	9/19/2023
Inactive	Rural Community Insurance Company	301891	Agent - Casualty	4/20/2009	4/8/2017
Inactive	Rural Community Insurance Company	301891	Agent - Property	4/20/2009	4/8/2017
Active	Security National Insurance Company	301151	Agent - Casualty	9/20/2017
Active	Security National Insurance Company	301151	Agent - Property	9/20/2017
Active	Sequoia Insurance Company	628046	Agent - Casualty	5/5/2020
Active	Sequoia Insurance Company	628046	Agent - Property	5/5/2020
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	10/21/2010	12/9/2013
Inactive	Star Insurance Company	301553	Agent - Casualty	3/14/2013	6/2/2014
Inactive	Star Insurance Company	301553	Agent - Property	3/14/2013	6/2/2014
Active	StarNet Insurance Company	502746	Agent - Health	8/8/2018
Active	Starr Indemnity and Liability Company	301685	Agent - Casualty	7/19/2021
Active	Starr Indemnity and Liability Company	301685	Agent - Property	7/19/2021
Active	Technology Insurance Company	613278	Agent - Casualty	9/20/2017
Active	Technology Insurance Company	613278	Agent - Property	9/20/2017
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	10/21/2010	12/9/2013
Inactive	The Phoenix Insurance Company	301502	Agent - Property	10/21/2010	12/9/2013
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	10/21/2010	12/9/2013
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	10/21/2010	12/14/2016
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	10/21/2010	12/14/2016
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	10/21/2010	12/9/2013
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	10/21/2010	12/9/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	10/21/2010	12/9/2013
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	10/21/2010	12/9/2013
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	10/21/2010	12/9/2013
Inactive	Watford Insurance Company	556753	Agent - Casualty	2/13/2019	1/31/2025
Inactive	Watford Insurance Company	556753	Agent - Property	2/13/2019	1/31/2025
Active	Wesco Insurance Company	300534	Agent - Casualty	9/20/2017
Active	Wesco Insurance Company	300534	Agent - Property	9/20/2017
Active	Westchester Fire Insurance Company	300990	Agent - Casualty	9/16/2015
Active	Westchester Fire Insurance Company	300990	Agent - Property	9/16/2015
Active	Zurich American Insurance Company	301121	Agent - Casualty	2/24/2010
Active	Zurich American Insurance Company	301121	Agent - Property	2/24/2010
Active	Zurich American Insurance Company of Illinois	301805	Agent - Casualty	2/24/2010
Active	Zurich American Insurance Company of Illinois	301805	Agent - Property	2/24/2010

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Agresti, Kathleen A	843687	Independent Adjuster - Property & Casualty	3/2/2017	6/7/2022
Inactive	Anderson, Curtis T	728813	Agent - Casualty	11/13/2012	4/8/2013
Inactive	Anderson, Curtis T	728813	Agent - Property	11/13/2012	4/8/2013
Denied	Anderson, Joshua Wayne	700587	Agent - Casualty
Denied	Anderson, Joshua Wayne	700587	Agent - Property
Inactive	Baughn, Kevin J	726636	Agent - Casualty	9/21/2012	3/14/2017
Inactive	Baughn, Kevin J	726636	Agent - Property	9/21/2012	3/14/2017
Inactive	Becker, Thomas	558554	Agent - Casualty	5/12/2008	4/15/2014
Inactive	Becker, Thomas	558554	Agent - Property	5/12/2008	4/15/2014
Active	Beckler, Shawn T	699184	Agent - Casualty	9/21/2012
Active	Beckler, Shawn T	699184	Agent - Property	9/21/2012
Active	Beckler, Shawn T	699184	Surplus Lines Broker - Not Applicable	9/21/2012
Inactive	Brogan, Kevin M.	618319	Agent - Casualty	2/28/2008	2/9/2009
Inactive	Brogan, Kevin M.	618319	Agent - Property	2/28/2008	2/9/2009
Inactive	Calderon, Luis A	675031	Agent - Casualty	11/12/2012	4/15/2014
Inactive	Calderon, Luis A	675031	Agent - Property	11/12/2012	4/15/2014
Active	Cash, Corey	631430	Agent - Casualty	9/21/2012
Active	Cash, Corey	631430	Agent - Health	5/29/2024
Active	Cash, Corey	631430	Agent - Life	5/29/2024
Active	Cash, Corey	631430	Agent - Property	11/12/2012
Active	Dalessio, Nicholas J	576577	Agent - Casualty	9/21/2012
Active	Dalessio, Nicholas J	576577	Agent - Property	9/21/2012
Denied	De Vries, Anne Patricia	728745	Agent - Casualty
Denied	De Vries, Anne Patricia	728745	Agent - Property
Inactive	Derouin, Brian E	614895	Agent - Casualty	9/21/2012	5/16/2014
Denied	Derouin, Brian E	614895	Agent - Health
Inactive	Derouin, Brian E	614895	Agent - Property	9/21/2012	5/16/2014
Inactive	Fauber, Carla M	681705	Agent - Casualty	9/21/2012	4/8/2013
Inactive	Fauber, Carla M	681705	Agent - Property	9/21/2012	4/8/2013
Inactive	Ferguson, Thomas A	700344	Agent - Casualty	9/21/2012	1/6/2025
Inactive	Ferguson, Thomas A	700344	Agent - Property	11/12/2012	1/6/2025
Inactive	Hatlem, David	343927	Agent - Casualty	10/30/2023	5/8/2024
Inactive	Hatlem, David	343927	Agent - Health	11/20/2023	5/8/2024
Inactive	Hatlem, David	343927	Agent - Life	11/20/2023	5/8/2024
Inactive	Hatlem, David	343927	Agent - Property	10/30/2023	5/8/2024
Inactive	Hollander, Susan	920514	Agent - Casualty	8/5/2016	10/9/2018
Denied	Hollander, Susan	920514	Agent - Health
Inactive	Hollander, Susan	920514	Agent - Property	8/5/2016	10/9/2018
Inactive	Lucas, Hubert	822694	Agent - Casualty	1/8/2014	10/31/2016
Inactive	Lucas, Hubert	822694	Agent - Property	1/8/2014	10/31/2016
Inactive	Mejia, Annette	635434	Agent - Casualty	4/7/2014	11/18/2015
Inactive	Mejia, Annette	635434	Agent - Property	4/7/2014	11/18/2015
Denied	Olsson, Elizabeth Leigh	701559	Agent - Casualty
Denied	Olsson, Elizabeth Leigh	701559	Agent - Property
Inactive	Patrick, Ryan H	726574	Agent - Casualty	9/21/2012	6/10/2024
Inactive	Patrick, Ryan H	726574	Agent - Property	11/16/2012	6/10/2024
Active	Paulk, John	813350	Agent - Casualty	3/18/2014
Active	Paulk, John	813350	Agent - Property	3/18/2014
Inactive	Paulk, John Irvine	392044	Agent - Casualty	3/18/2014	1/5/2016
Inactive	Paulk, John Irvine	392044	Agent - Property	3/18/2014	1/5/2016
Inactive	Paulk, John Irvine	392044	Surplus Lines Broker - Not Applicable	3/18/2014	1/5/2016
Active	Potter, Lori J	768460	Agent - Casualty	11/12/2012
Active	Potter, Lori J	768460	Agent - Property	11/12/2012
Inactive	Pozmantier, Jeffrey Louis	505617	Agent - Casualty	2/17/2009	10/30/2023
Inactive	Pozmantier, Jeffrey Louis	505617	Agent - Health	4/30/2014	10/30/2023
Inactive	Pozmantier, Jeffrey Louis	505617	Agent - Life	4/30/2014	10/30/2023
Inactive	Pozmantier, Jeffrey Louis	505617	Agent - Property	2/17/2009	10/30/2023
Inactive	Pozmantier, Jeffrey Louis	505617	Surplus Lines Broker - Not Applicable	2/17/2009	11/10/2023
Denied	Richards, Helen A	728024	Agent - Casualty
Denied	Richards, Helen A	728024	Agent - Property
Active	Riley, Mary Ellen	752636	Independent Adjuster - Property & Casualty	6/8/2011
Active	Riley, Mary Ellen	752636	Independent Adjuster - Workers' Compensation	6/8/2011
Inactive	Schreiber, Cheryn R	743001	Agent - Casualty	9/21/2012	4/25/2019
Inactive	Schreiber, Cheryn R	743001	Agent - Property	9/21/2012	4/25/2019
Active	Schulze, Mary Beth	511579	Independent Adjuster - Property & Casualty	9/21/2012
Inactive	Shopoff, Holly Lynn	318319	Agent - Casualty	2/17/2009	5/5/2009
Inactive	Shopoff, Holly Lynn	318319	Agent - Property	2/17/2009	5/5/2009
Inactive	Small, Patrick S	510004	Agent - Casualty	6/20/2007	4/30/2014
Inactive	Small, Patrick S	510004	Agent - Health	6/26/2009	4/30/2014
Inactive	Small, Patrick S	510004	Agent - Life	6/26/2009	4/30/2014
Inactive	Small, Patrick S	510004	Agent - Property	6/20/2007	4/30/2014
Inactive	Small, Patrick S	510004	Surplus Lines Broker - Not Applicable	4/3/2008	4/30/2014
Inactive	Snyder, Donald	541492	Agent - Casualty	7/17/2015	11/30/2020
Inactive	Snyder, Donald	541492	Agent - Property	7/17/2015	11/30/2020
Active	Thim, Cheryl A	717720	Agent - Casualty	11/12/2012
Active	Thim, Cheryl A	717720	Agent - Property	11/12/2012
Inactive	Trull, Joseph	881187	Agent - Casualty	11/10/2015	4/5/2023
Denied	Trull, Joseph	881187	Agent - Health
Inactive	Trull, Joseph	881187	Agent - Property	11/10/2015	4/5/2023
Denied	Wachenschwanz, Doreen A	507110	Agent - Casualty
Denied	Wachenschwanz, Doreen A	507110	Agent - Health
Denied	Wachenschwanz, Doreen A	507110	Agent - Property
Inactive	Walters, Trendolyn	925355	Independent Adjuster - Property & Casualty	8/23/2016	10/18/2024