DEPARTMENT OF INSURANCE
Affiliations
NameIndustria Risk & Insurance Services LLCDOIID987150NAIC NPN18512140
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentHealth3/13/20187/1/2019 
InactiveNon ResidentAgentProperty3/13/20183/31/2020 
InactiveNon ResidentAgentLife3/13/20187/1/2019 
InactiveNon ResidentAgentCasualty3/13/20183/31/2020 
InactiveNon ResidentSurplus Lines BrokerNot Applicable3/13/20183/31/2020 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAmerican Contractors Indemnity Company536843Agent - Casualty9/18/20183/31/2020
InactiveStarr Indemnity and Liability Company301685Agent - Casualty12/11/20194/24/2020
InactiveStarr Indemnity and Liability Company301685Agent - Property12/11/20194/24/2020
InactiveU.S. Specialty Insurance Company300186Agent - Casualty9/18/20183/31/2020
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveChavious, Glenn T 561726Agent - Casualty3/13/20186/13/2019
InactiveChavious, Glenn T 561726Agent - Health3/13/20186/13/2019
InactiveChavious, Glenn T 561726Agent - Life3/13/20186/13/2019
InactiveChavious, Glenn T 561726Agent - Property3/13/20186/13/2019
InactiveChavious, Glenn T 561726Surplus Lines Broker - Not Applicable3/13/20188/15/2019
DeniedMitilier, Jared Jay 634563Agent - Casualty  
DeniedMitilier, Jared Jay 634563Agent - Property  
InactiveMitilier, Jared Jay 634563Surplus Lines Broker - Not Applicable3/13/20181/16/2020
InactiveSagalow, Ty Rone 1014847Agent - Casualty6/13/20193/31/2020
InactiveSagalow, Ty Rone 1014847Agent - Property6/13/20193/31/2020
InactiveSagalow, Ty Rone 1014847Surplus Lines Broker - Not Applicable6/13/20193/31/2020

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