DEPARTMENT OF INSURANCE

Affiliations

Name	Evergreen Ins LLC	DOIID	979440	NAIC NPN	18617383

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	12/15/2017	3/31/2027
Active	Non Resident	Agent	Health	12/15/2017	3/31/2027
Active	Non Resident	Agent	Casualty	12/15/2017	3/31/2027
Active	Non Resident	Agent	Property	12/15/2017	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	02/10/2025	02/10/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	AXIS Insurance Company	301290	Agent - Casualty	1/19/2024
Active	AXIS Insurance Company	301290	Agent - Property	1/19/2024
Active	AmTrust Insurance Company	300179	Agent - Casualty	11/9/2022
Active	AmTrust Insurance Company	300179	Agent - Property	11/9/2022
Inactive	American Economy Insurance Company	300315	Agent - Casualty	9/28/2023	3/29/2024
Inactive	American Economy Insurance Company	300315	Agent - Property	9/28/2023	3/29/2024
Active	Arch Indemnity Insurance Company	301459	Agent - Casualty	12/29/2021
Active	Arch Indemnity Insurance Company	301459	Agent - Property	12/29/2021
Active	Arch Insurance Company	300688	Agent - Casualty	3/24/2020
Active	Arch Insurance Company	300688	Agent - Property	3/24/2020
Inactive	Cincinnati Insurance Company	301298	Agent - Casualty	1/17/2018	3/7/2019
Inactive	Cincinnati Insurance Company	301298	Agent - Property	1/17/2018	3/7/2019
Active	Continental Indemnity Company	301905	Agent - Casualty	5/24/2024
Active	Continental Indemnity Company	301905	Agent - Health	5/24/2024
Active	Continental Indemnity Company	301905	Agent - Property	5/24/2024
Active	Meridian Security Insurance Company	300423	Agent - Casualty	1/30/2018
Active	Meridian Security Insurance Company	300423	Agent - Property	1/30/2018
Active	Milbank Insurance Company	925185	Agent - Casualty	1/30/2018
Active	Milbank Insurance Company	925185	Agent - Property	1/30/2018
Active	Milford Casualty Insurance Company	301460	Agent - Casualty	11/9/2022
Active	Milford Casualty Insurance Company	301460	Agent - Property	11/9/2022
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	6/14/2024
Active	Ohio Casualty Insurance Company	301492	Agent - Property	6/14/2024
Active	Pennsylvania Insurance Company	301219	Agent - Casualty	5/24/2024
Active	Pennsylvania Insurance Company	301219	Agent - Property	5/24/2024
Active	Rockwood Casualty Insurance Company	585116	Agent - Casualty	1/2/2018
Active	Rockwood Casualty Insurance Company	585116	Agent - Property	1/2/2018
Active	Security National Insurance Company	301151	Agent - Casualty	11/9/2022
Active	Security National Insurance Company	301151	Agent - Property	11/9/2022
Active	Sequoia Insurance Company	628046	Agent - Casualty	11/9/2022
Active	Sequoia Insurance Company	628046	Agent - Property	11/9/2022
Active	SiriusPoint America Insurance Company	301148	Agent - Casualty	5/24/2024
Active	SiriusPoint America Insurance Company	301148	Agent - Property	5/24/2024
Active	State Auto Property & Casualty Insurance Company	301953	Agent - Casualty	1/30/2018
Active	State Auto Property & Casualty Insurance Company	301953	Agent - Property	1/30/2018
Active	State Automobile Mutual Insurance Company	301824	Agent - Casualty	1/30/2018
Active	State Automobile Mutual Insurance Company	301824	Agent - Property	1/30/2018
Active	Technology Insurance Company	613278	Agent - Casualty	11/9/2022
Active	Technology Insurance Company	613278	Agent - Property	11/9/2022
Active	Wesco Insurance Company	300534	Agent - Casualty	11/9/2022
Active	Wesco Insurance Company	300534	Agent - Property	11/9/2022

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Pending Replacement	Champe, David W	692145	Agent - Health	12/15/2017
Pending Replacement	Champe, David W	692145	Agent - Life	12/15/2017
Active	Imler, Joseph R	659505	Agent - Casualty	12/15/2017
Active	Imler, Joseph R	659505	Agent - Property	12/15/2017
Inactive	Snyder, Dale B	683199	Agent - Casualty	12/20/2017	12/16/2021
Inactive	Snyder, Dale B	683199	Agent - Property	12/20/2017	12/16/2021