DEPARTMENT OF INSURANCE

Affiliations

Name	Impact Risk Solutions LLC	DOIID	669714	NAIC NPN	9927829

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Casualty	12/6/2007	11/16/2012
Inactive	Non Resident	Agent	Property	12/6/2007	11/16/2012
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	3/6/2008	11/16/2012
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AIG Assurance Company	300897	Agent - Casualty	3/4/2008	11/16/2012
Inactive	AIG Assurance Company	300897	Agent - Property	3/4/2008	11/16/2012
Inactive	AIG Property Casualty Company	300621	Agent - Casualty	3/4/2008	11/16/2012
Inactive	AIG Property Casualty Company	300621	Agent - Property	3/4/2008	11/16/2012
Inactive	American Home Assurance Company	300246	Agent - Casualty	3/4/2008	11/16/2012
Inactive	American Home Assurance Company	300246	Agent - Property	3/4/2008	11/16/2012
Inactive	Commerce and Industry Insurance Company	300881	Agent - Casualty	3/4/2008	11/16/2012
Inactive	Commerce and Industry Insurance Company	300881	Agent - Property	3/4/2008	11/16/2012
Inactive	Granite State Insurance Company	300818	Agent - Casualty	3/4/2008	11/16/2012
Inactive	Granite State Insurance Company	300818	Agent - Property	3/4/2008	11/16/2012
Inactive	Illinois National Insurance Company	301367	Agent - Casualty	3/4/2008	11/16/2012
Inactive	Illinois National Insurance Company	301367	Agent - Property	3/4/2008	11/16/2012
Inactive	Insurance Company of the State of Pennsylvania	300807	Agent - Casualty	3/4/2008	11/16/2012
Inactive	Insurance Company of the State of Pennsylvania	300807	Agent - Property	3/4/2008	11/16/2012
Inactive	LM Insurance Corporation	301061	Agent - Casualty	11/24/2009	11/16/2012
Inactive	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	11/24/2009	11/16/2012
Inactive	Liberty Mutual Insurance Company	301159	Agent - Casualty	11/24/2009	11/16/2012
Inactive	Merchants Bonding Company (Mutual)	300170	Agent - Casualty	6/23/2010	8/31/2012
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	3/4/2008	11/16/2012
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	3/4/2008	11/16/2012
Inactive	New Hampshire Insurance Company	301670	Agent - Casualty	3/4/2008	11/16/2012
Inactive	New Hampshire Insurance Company	301670	Agent - Property	3/4/2008	11/16/2012
Inactive	Union Insurance Company	547433	Agent - Casualty	12/23/2011	11/16/2012
Inactive	Union Insurance Company	547433	Agent - Property	12/23/2011	11/16/2012

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Boulton, Rhesa F.	655071	Surplus Lines Broker - Not Applicable	3/6/2008	11/16/2012
Inactive	Halvorsen, Marc Vern	568607	Agent - Casualty	12/6/2007	11/16/2012
Inactive	Halvorsen, Marc Vern	568607	Agent - Property	12/6/2007	11/16/2012
Inactive	Halvorsen, Marc Vern	568607	Surplus Lines Broker - Not Applicable	3/6/2008	12/12/2019