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	Property	12/15/2017	3/31/2027
Active	Non Resident	Agent	Casualty	12/15/2017	3/31/2027
Pending Replacement	Non Resident	Agent	Life	12/15/2017	3/31/2027
Pending Replacement	Non Resident	Agent	Health	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.

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
Pending Replacement	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
Inactive	Champe, David W	692145	Agent - Health	12/15/2017	4/30/2025
Inactive	Champe, David W	692145	Agent - Life	12/15/2017	4/30/2025
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