DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Deep South Surplus Inc	DOIID	701045	NAIC NPN	3471141

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	3/6/2009	1/18/2018
Inactive	Non Resident	Agent	Property	3/6/2009	1/18/2018
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	3/17/2009	2/2/2017
* 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	North Pointe Insurance Company	301029	Agent - Casualty	12/11/2012	11/30/2015
Inactive	North Pointe Insurance Company	301029	Agent - Property	12/11/2012	11/30/2015
Inactive	Praetorian Insurance Company	301021	Agent - Casualty	4/27/2009	1/18/2018
Inactive	Praetorian Insurance Company	301021	Agent - Property	4/27/2009	1/18/2018
Inactive	QBE Insurance Corporation	300515	Agent - Casualty	12/11/2012	11/30/2015
Inactive	QBE Insurance Corporation	300515	Agent - Property	12/11/2012	11/30/2015
Inactive	Redland Insurance Company	300687	Agent - Casualty	3/17/2009	3/31/2010
Inactive	Redland Insurance Company	300687	Agent - Property	3/17/2009	3/31/2010

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Forsythe, Victoria Charlotte	578072	Surplus Lines Broker - Not Applicable	3/17/2009	7/12/2012
Inactive	Gibbs, Kristi Lynn	645599	Agent - Casualty	3/6/2009	8/5/2011
Inactive	Gibbs, Kristi Lynn	645599	Agent - Property	3/6/2009	8/5/2011
Inactive	Gibbs, Kristi Lynn	645599	Surplus Lines Broker - Not Applicable	4/17/2009	8/5/2011
Inactive	Hamilton, Tyler Mark	869407	Agent - Casualty	1/10/2017	1/18/2018
Inactive	Hamilton, Tyler Mark	869407	Agent - Property	1/10/2017	1/18/2018
Inactive	Hughes, James Kenneth	598839	Agent - Casualty	3/26/2013	8/22/2016
Inactive	Hughes, James Kenneth	598839	Agent - Property	3/26/2013	8/22/2016
Inactive	Hughes, James Kenneth	598839	Surplus Lines Broker - Not Applicable	3/26/2013	8/22/2016
Inactive	Lowry, Michelle Rene	906182	Agent - Casualty	8/22/2016	1/10/2017
Inactive	Lowry, Michelle Rene	906182	Agent - Property	8/22/2016	1/10/2017
Inactive	Lowry, Michelle Rene	906182	Surplus Lines Broker - Not Applicable	8/22/2016	1/10/2017
Inactive	Tappel, Craig Ahern	560540	Agent - Casualty	4/21/2011	3/26/2013
Inactive	Tappel, Craig Ahern	560540	Agent - Property	4/21/2011	3/26/2013
Inactive	Tappel, Craig Ahern	560540	Surplus Lines Broker - Not Applicable	4/21/2011	3/26/2013