DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Brentwood Reinsurance Intermediaries Inc	DOIID	778833	NAIC NPN	9582287

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	4/5/2012		3/31/2026
Active	Non Resident	Agent	Casualty	4/5/2012		3/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	4/1/2014		3/31/2026
* 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
Active	Arch Insurance Company	300688	Agent - Casualty	4/11/2013
Active	Arch Insurance Company	300688	Agent - Property	4/11/2013
Inactive	Gray Insurance Company (The)	301532	Agent - Casualty	5/18/2017	12/19/2023
Inactive	Gray Insurance Company (The)	301532	Agent - Property	5/18/2017	12/19/2023
Active	Midwest Employers Casualty Company	300124	Agent - Casualty	12/7/2012
Active	Midwest Employers Casualty Company	300124	Agent - Property	12/7/2012

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Fawcett, Keith	383998	Agent - Casualty	4/9/2012
Active	Fawcett, Keith	383998	Agent - Property	4/9/2012
Inactive	Hammer, Richard Douglas	364830	Agent - Casualty	11/1/2013	11/16/2022
Inactive	Hammer, Richard Douglas	364830	Agent - Property	11/1/2013	11/16/2022
Active	Peterson, Heather N	1142920	Agent - Casualty	7/29/2021
Active	Peterson, Heather N	1142920	Agent - Property	7/29/2021
Inactive	Raley, Lisa Renee	551701	Agent - Casualty	11/1/2013	12/7/2022
Inactive	Raley, Lisa Renee	551701	Agent - Property	11/1/2013	12/7/2022
Active	Wilson, Dawn	507147	Agent - Casualty	4/5/2012
Active	Wilson, Dawn	507147	Agent - Property	4/5/2012
Active	Wilson, Dawn	507147	Surplus Lines Broker - Not Applicable	4/1/2014