DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ethos Specialty Insurance Services LP	DOIID	975725	NAIC NPN	18559234

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	9/11/2020		3/31/2027
Active	Non Resident	Agent	Property	9/11/2020		3/31/2027
Denied	Non Resident	Agent	Self-Service Storage Space
Inactive	Non Resident	Agent	Personal Lines	11/6/2017	2/25/2020
Inactive	Non Resident	Agent	Travel	11/6/2017	2/25/2020
Active	Non Resident	Surplus Lines Broker	Not Applicable	11/6/2017		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	01/15/2027	03/31/2027
Surplus Lines Broker	01/15/2027	03/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Ascot Insurance Company	301516	Agent - Casualty	6/18/2021
Active	Ascot Insurance Company	301516	Agent - Property	6/18/2021
Active	Imperium Insurance Company	300804	Agent - Casualty	11/6/2025
Active	Imperium Insurance Company	300804	Agent - Property	11/6/2025
Active	Starr Indemnity and Liability Company	301685	Agent - Casualty	9/11/2025
Active	Starr Indemnity and Liability Company	301685	Agent - Property	9/11/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Meizlik, Justin	974311	Agent - Casualty	11/6/2017	2/25/2020
Inactive	Meizlik, Justin	974311	Agent - Personal Lines	11/6/2017	2/25/2020
Inactive	Meizlik, Justin	974311	Agent - Property	11/6/2017	2/25/2020
Inactive	Meizlik, Justin	974311	Agent - Travel	11/6/2017	2/25/2020
Inactive	Meizlik, Justin	974311	Surplus Lines Broker - Not Applicable	11/6/2017	2/25/2020
Active	Meyer, Lauren Marie	1212963	Agent - Casualty	11/6/2025
Active	Meyer, Lauren Marie	1212963	Agent - Property	11/6/2025
Active	Meyer, Lauren Marie	1212963	Surplus Lines Broker - Not Applicable	11/6/2025
Inactive	Paulson, Jesse	782661	Agent - Casualty	10/3/2024	11/21/2024
Inactive	Paulson, Jesse	782661	Agent - Property	10/3/2024	11/21/2024
Inactive	Paulson, Jesse	782661	Surplus Lines Broker - Not Applicable	10/3/2024	11/21/2024
Inactive	Petcoff, Nicholas James	749880	Agent - Casualty	11/21/2024	11/6/2025
Inactive	Petcoff, Nicholas James	749880	Agent - Property	11/21/2024	11/6/2025
Inactive	Petcoff, Nicholas James	749880	Surplus Lines Broker - Not Applicable	11/21/2024	11/6/2025
Inactive	Schnell, Adam M	1033787	Agent - Casualty	9/11/2020	10/3/2024
Inactive	Schnell, Adam M	1033787	Agent - Property	9/11/2020	10/3/2024
Denied	Schnell, Adam M	1033787	Agent - Travel
Inactive	Schnell, Adam M	1033787	Surplus Lines Broker - Not Applicable	5/14/2019	10/3/2024