DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Platinum Partners X S Services LLC	DOIID	806305	NAIC NPN	16199083

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	3/22/2013	3/31/2017
Inactive	Non Resident	Agent	Property	3/22/2013	3/31/2017
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	3/22/2013	11/17/2016
* 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	American Modern Home Insurance Company	300791	Agent - Casualty	7/7/2016	3/31/2017
Inactive	American Modern Home Insurance Company	300791	Agent - Property	7/7/2016	3/31/2017
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	7/7/2016	3/31/2017
Inactive	American Modern Select Insurance Company	581481	Agent - Property	7/7/2016	3/31/2017
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	7/7/2016	3/31/2017
Inactive	American Southern Home Insurance Company	626276	Agent - Property	7/7/2016	3/31/2017

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Derosa, Timothy Buckley	802073	Agent - Casualty	3/22/2013	3/31/2017
Inactive	Derosa, Timothy Buckley	802073	Agent - Property	3/22/2013	3/31/2017
Inactive	Derosa, Timothy Buckley	802073	Surplus Lines Broker - Not Applicable	3/22/2013	1/31/2022