DEPARTMENT OF INSURANCE

Insurer Details

NAME	Evergreen National Indemnity Company
DOI ID	300146
FEIN #	362467238
ALIEN #
State of Domicile	OH
Domicile Country
Merged Into
NAIC #	12750
NAIC Group #	4869
Entity Type	Insurer
Admitted	12/11/1959
AM Best Rating
President	Robert W Shepard
Process Agent	CT Corp Date Assigned : 12/13/2022 (See address table below for process agent address)
Authorized Insurer – these insurers are authorized to do the business of insurance by holding a Kentucky Certificate of Authority. Provides insurance coverage.

Line(s) of Authority

Property

Surety

Casualty
Vehicle Insurance
Liability Insurance
Workers' Compensation & Employer's Liability
Burglary & Theft
Personal Property Floater
Glass
Boiler & Machinery
Leakage & Fire Extinguishing Equipment
Elevator
Livestock
Entertainments
Miscellaneous

Marine & Transportation

Type	Address
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Additional Business Location 1	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Agent Licensing Address	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Annual Statement	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Mailing	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131
Process Agent	Attn: Susan Johnson 306 W. Main St. Suite 512 Frankfort, KY 40601
Statutory Home Office	6150 Oak Tree Blvd. Suite 440 Independence, OH 44131

Type	Number
Consumer Complaint - Business / Home Office	(440) 229-3420
Catastrophe/Disaster Coordination Contact - Business / Home Office	(440) 229-3420
Claim Information Contact - Business / Home Office	(440) 229-3420
Company Licenses/Fees Contact - Business / Home Office	(440) 229-3420
Cyber Security - Business / Home Office	(440) 229-3420
Deposits Contact - Business / Home Office	(440) 229-3402
Local Office in Domestic/Foreign State Contact - Business / Home Office	(440) 229-3420
Managing General Agent - Business / Home Office	(440) 229-3420
Policyholder Information Contact - Business / Home Office	(440) 229-3420
Regulatory Compliance/Gvmt Relations Contact - Business / Home Office	(440) 229-3420
U.S. Legal Counsel for aliens - Business / Home Office	(440) 229-3420
Business / Home Office	(440) 229-3420
Annual Statement - Fax	(440) 229-3421
U.S. Legal Counsel for aliens - Fax	(440) 229-3421
Catastrophe/Disaster Coordination Contact - Fax	(440) 229-3421
Claim Information Contact - Fax	(440) 229-3421
Company Licenses/Fees Contact - Fax	(440) 229-3421
Cyber Security - Fax	(440) 229-3421
Consumer Complaint - Fax	(440) 229-3421
Deposits Contact - Fax	(440) 229-3421
Local Office in Domestic/Foreign State Contact - Fax	(440) 229-3421
Policyholder Information Contact - Fax	(440) 229-3421
Premium Tax Contact - Fax	(440) 229-3421
Licensing - Fax	(440) 229-3421
Regulatory Compliance/Gvmt Relations Contact - Fax	(440) 229-3421
Regulatory Compliance/Gvmt Relations Contact - Fax	(440) 229-3421
Licensing - Agent Licensing Phone	(440) 229-3420
Annual Statement - Annual Statement	(440) 229-3403
Premium Tax Contact - Premium Tax	(440) 229-3420

Type	Internet Information
Licensing - Business Email	regulatory@evergreen-national.com
Annual Statement - Business Email	dcanzone@evergreen-national.com
Consumer Complaint - Business Email	regulatory@evergreen-national.com
Catastrophe/Disaster Coordination Contact - Business Email	regulatory@evergreen-national.com
Claim Information Contact - Business Email	regulatory@evergreen-national.com
Company Licenses/Fees Contact - Business Email	regulatory@evergreen-national.com
Cyber Security - Business Email	regulatory@evergreen-national.com
Deposits Contact - Business Email	ojlombard@evergreen-national.com
Local Office in Domestic/Foreign State Contact - Business Email	regulatory@evergreen-national.com
Managing General Agent - Business Email	regulatory@evergreen-national.com
Policyholder Information Contact - Business Email	regulatory@evergreen-national.com
Premium Tax Contact - Business Email	regulatory@evergreen-national.com
Regulatory Compliance/Gvmt Relations Contact - Business Email	regulatory@evergreen-national.com
U.S. Legal Counsel for aliens - Business Email	regulatory@evergreen-national.com