DEPARTMENT OF INSURANCE

Affiliations

Name	Embroker Ins Services LLC	DOIID	901870	NAIC NPN	17701177

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	10/24/2016		3/31/2025
Active	Non Resident	Agent	Property	12/15/2015		3/31/2025
Active	Non Resident	Agent	Casualty	12/15/2015		3/31/2025
Active	Non Resident	Agent	Health	10/24/2016		3/31/2025
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	7/31/2017	8/1/2023
* 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

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	2/8/2017
Active	ACE American Insurance Company	300625	Agent - Property	2/8/2017
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	2/8/2017
Active	ACE Fire Underwriters Insurance Company	301679	Agent - Property	2/8/2017
Active	ACE Property and Casualty Insurance Company	300520	Agent - Casualty	2/8/2017
Active	ACE Property and Casualty Insurance Company	300520	Agent - Property	2/8/2017
Active	Allmerica Financial Alliance Insurance Company	300823	Agent - Casualty	7/11/2016
Active	Allmerica Financial Alliance Insurance Company	300823	Agent - Property	7/11/2016
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Casualty	7/11/2016
Active	Allmerica Financial Benefit Insurance Company	301223	Agent - Property	7/11/2016
Active	Arch Insurance Company	300688	Agent - Casualty	12/28/2017
Active	Arch Insurance Company	300688	Agent - Property	12/28/2017
Active	Berkley Insurance Company	301355	Agent - Casualty	8/8/2018
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	5/10/2016	11/30/2017
Active	Chubb National Insurance Company	301392	Agent - Casualty	2/8/2017
Active	Chubb National Insurance Company	301392	Agent - Property	2/8/2017
Active	Continental Casualty Company	301019	Agent - Casualty	12/16/2019
Active	Continental Casualty Company	301019	Agent - Property	12/16/2019
Inactive	Employers Assurance Company	300120	Agent - Casualty	7/7/2016	9/9/2022
Inactive	Employers Compensation Insurance Company	797885	Agent - Casualty	8/6/2018	9/9/2022
Inactive	Employers Preferred Insurance Company	520656	Agent - Casualty	7/7/2016	9/9/2022
Active	Everest National Insurance Company	301319	Agent - Casualty	9/26/2019
Active	Everest National Insurance Company	301319	Agent - Property	9/26/2019
Active	Executive Risk Indemnity Inc.	301510	Agent - Casualty	2/2/2018
Inactive	Farmington Casualty Company	301137	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Farmington Casualty Company	301137	Agent - Property	5/10/2016	11/30/2017
Active	Federal Insurance Company	301144	Agent - Casualty	2/8/2017
Active	Federal Insurance Company	301144	Agent - Property	2/8/2017
Active	Fidelity and Guaranty Insurance Company	301009	Agent - Casualty	5/26/2022
Active	Fidelity and Guaranty Insurance Company	301009	Agent - Property	5/26/2022
Active	Great American Alliance Insurance Company	301247	Agent - Casualty	10/30/2019
Active	Great American Alliance Insurance Company	301247	Agent - Property	10/30/2019
Active	Great American Assurance Company	300327	Agent - Casualty	10/30/2019
Active	Great American Assurance Company	300327	Agent - Property	10/30/2019
Active	Great American Insurance Company	301586	Agent - Casualty	10/30/2019
Active	Great American Insurance Company	301586	Agent - Property	10/30/2019
Active	Great American Spirit Insurance Company	300233	Agent - Casualty	10/30/2019
Active	Great American Spirit Insurance Company	300233	Agent - Property	10/30/2019
Active	Great Northern Insurance Company	301107	Agent - Casualty	2/8/2017
Active	Great Northern Insurance Company	301107	Agent - Property	2/8/2017
Active	Greenwich Insurance Company	301754	Agent - Casualty	8/20/2019
Active	Greenwich Insurance Company	301754	Agent - Property	8/20/2019
Active	Hanover American Insurance Company (The)	300447	Agent - Casualty	7/11/2016
Active	Hanover American Insurance Company (The)	300447	Agent - Property	7/11/2016
Active	Hanover Insurance Company (The)	300508	Agent - Casualty	7/11/2016
Active	Hanover Insurance Company (The)	300508	Agent - Property	7/11/2016
Active	Hartford Accident and Indemnity Company	301917	Agent - Casualty	11/10/2021
Active	Hartford Accident and Indemnity Company	301917	Agent - Property	11/10/2021
Active	Hartford Insurance Company of the Southeast	1014204	Agent - Casualty	7/4/2021
Active	Hartford Insurance Company of the Southeast	1014204	Agent - Property	7/4/2021
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	4/11/2017
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	4/11/2017
Active	Hartford Underwriters Insurance Company	301064	Agent - Casualty	4/19/2021
Active	Hartford Underwriters Insurance Company	301064	Agent - Property	4/19/2021
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	2/14/2017	4/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	2/14/2017	4/10/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	2/14/2017	12/8/2017
Inactive	Kanawha Insurance Company	300127	Agent - Life	2/14/2017	12/8/2017
Active	Massachusetts Bay Insurance Company	300898	Agent - Casualty	7/11/2016
Active	Massachusetts Bay Insurance Company	300898	Agent - Property	7/11/2016
Active	Midvale Indemnity Company	300292	Agent - Casualty	12/18/2017
Active	Midvale Indemnity Company	300292	Agent - Property	12/18/2017
Active	Pacific Indemnity Company	301610	Agent - Casualty	2/8/2017
Active	Pacific Indemnity Company	301610	Agent - Property	2/8/2017
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Casualty	12/7/2016	11/30/2017
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Property	12/7/2016	11/30/2017
Inactive	St. Paul Guardian Insurance Company	301372	Agent - Casualty	12/7/2016	11/30/2017
Inactive	St. Paul Guardian Insurance Company	301372	Agent - Property	12/7/2016	11/30/2017
Inactive	St. Paul Mercury Insurance Company	300783	Agent - Casualty	12/7/2016	11/30/2017
Inactive	St. Paul Mercury Insurance Company	300783	Agent - Property	12/7/2016	11/30/2017
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	5/10/2016	11/30/2017
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	5/10/2016	11/30/2017
Inactive	The Phoenix Insurance Company	301502	Agent - Property	5/10/2016	11/30/2017
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	5/10/2016	11/30/2017
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	5/10/2016	11/30/2017
Inactive	Travelers Casualty and Surety Company of America	301334	Agent - Casualty	12/24/2019	11/4/2022
Inactive	Travelers Casualty and Surety Company of America	301334	Agent - Property	12/24/2019	11/4/2022
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	5/10/2016	11/30/2017
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	5/10/2016	11/30/2017
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	5/10/2016	11/30/2017
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	5/10/2016	11/30/2017
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	5/10/2016	11/30/2017
Active	Twin City Fire Insurance Company	300721	Agent - Casualty	5/7/2017
Active	Twin City Fire Insurance Company	300721	Agent - Property	5/7/2017
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/20/2017	5/31/2023
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	10/20/2017	5/31/2023
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	10/20/2017	5/31/2023
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/1/2021	5/31/2023
Active	Valley Forge Insurance Company	301052	Agent - Casualty	12/16/2019
Active	Valley Forge Insurance Company	301052	Agent - Property	12/16/2019
Active	Vigilant Insurance Company	301143	Agent - Casualty	2/8/2017
Active	Vigilant Insurance Company	301143	Agent - Property	2/8/2017
Active	Westchester Fire Insurance Company	300990	Agent - Casualty	2/8/2017
Active	Westchester Fire Insurance Company	300990	Agent - Property	2/8/2017

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Derigiotis, David A	1248564	Agent - Casualty
Denied	Derigiotis, David A	1248564	Agent - Property
Active	Mangan, Thomas L	722099	Agent - Health	10/24/2016
Active	Mangan, Thomas L	722099	Agent - Life	10/24/2016
Inactive	Miller, Matthew Cowan	889698	Agent - Casualty	12/15/2015	10/4/2023
Inactive	Miller, Matthew Cowan	889698	Agent - Property	12/15/2015	10/4/2023
Inactive	Miller, Matthew Cowan	889698	Surplus Lines Broker - Not Applicable	7/31/2017	5/31/2023
Active	Noonan, Julie N	817360	Agent - Casualty	10/4/2022
Active	Noonan, Julie N	817360	Agent - Property	10/4/2022