DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Carosi, Michael	DOIID	842872	NAIC NPN	17286576

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	6/11/2014		6/30/2026
Active	Non Resident	Agent	Property	6/11/2014		6/30/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	7/21/2014		6/30/2026
* 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	04/15/2024	06/30/2024	04/22/2024	04/22/2024	Yes
Surplus Lines Broker	04/15/2024	06/30/2024	04/22/2024	04/22/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	6/20/2014	10/24/2018
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	6/20/2014	10/24/2018
Inactive	Vault Reciprocal Exchange	1040481	Agent - Casualty	3/14/2022	3/18/2024
Inactive	Vault Reciprocal Exchange	1040481	Agent - Property	3/14/2022	3/18/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Risk Specialists Companies Ins Agency Inc	669694	Agent - Property	7/2/2014	10/24/2018
Inactive	Risk Specialists Companies Ins Agency Inc	669694	Agent - Casualty	7/2/2014	7/27/2018
Inactive	Risk Specialists Companies Ins Agency Inc	669694	Surplus Lines Broker - Not Applicable	7/30/2014	2/20/2019