black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

C M I C SPECIALTY SERVICES INC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN134460
Status:
First Licensure:
12/09/2006
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
3000 SCHUSTER LN
MERRILL, WI 54452-3863
Mailing:
PO BOX 357
MERRILL, WI 54452-0357
Phone:
+1 (715) 536-5577
Fax:
+1 (715) 539-4958
Email:
sdavisson@churchmutual.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 12/09/2006 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN FAMILY HOME INSURANCE
04/22/2020 PCF201383
HARTFORD FIRE INSURANCE COMPANY
08/31/2020 PCF464
MOUNT VERNON FIRE INSURANCE COMPANY
04/18/2024 PCF83792
RLI INSURANCE COMPANY
08/04/2021 PCF695 06/27/2024
SECURITY NATIONAL INSURANCE COMPANY
10/01/2015 PCF189490
TECHNOLOGY INSURANCE COMPANY INC
10/01/2015 PCF136874
WESCO INSURANCE COMPANY
10/01/2015 PCF49735

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
TAMMY L. ADKINS
09/07/2023 PRN417165
KENNETH D. CHAPPELL
06/07/2022 PRN168854
ZOLAIDA COOPER
06/07/2022 PRN101928
LORI A. COVELLI
09/07/2023 PRN357612
STEPHANIE L. DIMODICA
09/07/2023 PRR440159
ANN H. GIVENS
01/25/2024 PRN440829
SCOTT MICHAEL HEMINGWAY
06/07/2022 PRR394527
TODD MICHAEL HOYT
11/12/2013 PRR153459
BRIAN M. MASSEY
06/07/2022 PRN386116
ELIZABETH C. MYERS
06/07/2022 PRN417712
ALEXIS ANTONIO PEREZ
09/08/2020 PRN323316
LAURA JO ROGGERO
06/07/2022 PRN279786

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
ELIZABETH C. MYERS PRN417712

Contacts

Type Contact
PRODUCER LICENSING CONTACT SHARON DAVISSON
SHARON DAVISSON
3000 SCHUSTER LN
MERRILL, WI 54452-3863
Phone: +1 (715) 536-5577
Email: sdavisson@churchmutual.com

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
8731093

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 05/14/2025 04:23:01 AM