DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Shaffer, Derek	DOIID	765692	NAIC NPN	9183433

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	10/4/2011		3/31/2027
Active	Non Resident	Agent	Property	10/4/2011		3/31/2027
Active	Non Resident	Surplus Lines Broker	Not Applicable	10/4/2011		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	01/30/2025	01/30/2025	Yes
Surplus Lines Broker	01/15/2025	03/31/2025	01/30/2025	01/30/2025	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	3/29/2015
Active	ACE American Insurance Company	300625	Agent - Property	3/29/2015
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	3/29/2015
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Property	3/29/2015
Active	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	3/29/2015
Active	ACE Property and Casualty Insurance Company	300520	Agent - Property	3/29/2015
Active	Arch Insurance Company	300688	Agent - Casualty	12/21/2016
Active	Arch Insurance Company	300688	Agent - Property	12/21/2016
Active	Pacific Employers Insurance Company	301753	Agent - Casualty	3/29/2015
Active	Pacific Employers Insurance Company	301753	Agent - Property	3/29/2015
Active	Westchester Fire Insurance Company	300990	Agent - Casualty	3/29/2015
Active	Westchester Fire Insurance Company	300990	Agent - Property	3/29/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	CRC Ins Services, LLC	502276	Agent - Property	12/5/2022
Active	CRC Ins Services, LLC	502276	Agent - Casualty	12/5/2022
Active	CRC Ins Services, LLC	502276	Surplus Lines Broker - Not Applicable	12/5/2022