DEPARTMENT OF INSURANCE

Name	Carbon Insurance Agency, LLC	DOIID	1288181	NAIC NPN	20790750

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	1/10/2025	3/31/2027
Active	Non Resident	Agent	Property	1/10/2025	3/31/2027
Active	Non Resident	Surplus Lines Broker	Not Applicable	10/13/2023	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	03/04/2025	03/04/2025	Yes
Surplus Lines Broker	01/15/2025	03/31/2025	01/06/2025	01/06/2025	Yes

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Business / Home Office	1389 Center Dr Ste 200 Park City, UT 840987660

Internet Information

Type	Address
Business Email	AGENCY@CARBONINSURANCE.CO

Phone Information

Type	Phone
Business / Home Office	(435) 200-3222