Individual Information

NICK N ANTONOV

BEAVERTON, OR 97008-7105

Active

nick@stagstoneins.com

04/17/2020

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3538299	04/17/2020	Active	04/17/2020	04/30/2026

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	04/17/2020	Active	04/17/2020
Health	04/17/2020	Active	04/17/2020
Life	04/17/2020	Active	04/17/2020
Property	04/17/2020	Active	04/17/2020

Company Name	Appointment Type	Status	Active Date
100311
AMTRUST INSURANCE COMPANY	Casualty	Active	07/31/2021
	Property	Active	07/31/2021
1125
Company Name	Appointment Type	Status	Active Date
GREAT AMERICAN ASSURANCE COMPANY	Casualty	Active	04/23/2020
	Property	Active	04/23/2020
100334
Company Name	Appointment Type	Status	Active Date
MILFORD CASUALTY INSURANCE COMPANY	Casualty	Active	07/31/2021
	Property	Active	07/31/2021
100333
Company Name	Appointment Type	Status	Active Date
SECURITY NATIONAL INSURANCE COMPANY	Casualty	Active	07/31/2021
	Property	Active	07/31/2021
1702
Company Name	Appointment Type	Status	Active Date
SEQUOIA INSURANCE COMPANY	Casualty	Active	07/31/2021
	Property	Active	07/31/2021
17636
Company Name	Appointment Type	Status	Active Date
TECHNOLOGY INSURANCE COMPANY INC	Casualty	Active	07/31/2021
	Property	Active	07/31/2021
1614
Company Name	Appointment Type	Status	Active Date
WESCO INSURANCE COMPANY	Casualty	Active	07/31/2021
	Property	Active	07/31/2021

row(s) 1 - 14 of 14

Organization	Association Type	Type	Beg dte	End dte
STAGSTONE RISK MANAGEMENT, LLC	Designated Resp Lic Prdcr	Agency	04/23/2020	-

1 - 1