black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

ORIGIN SPECIALTY UNDERWRITERS AGENCY, LLC.

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN465791
Status:
First Licensure:
10/04/2023
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
1701 GOLF RD STE 1001
ROLLING MEADOWS, IL 60008-4227
Mailing:
1701 GOLF RD STE 1001
ROLLING MEADOWS, IL 60008-4227
Phone:
+1 (847) 278-0506
Fax:
+1 (718) 228-2501
Email:
origin@3hcs.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 10/04/2023 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN GUARANTEE & LIABILITY INSURANCE COMPANY
11/11/2024 PCF366
AMERICAN ZURICH INSURANCE COMPANY
11/11/2024 PCF914
GREAT AMERICAN ALLIANCE INSURANCE COMPANY
05/10/2024 PCF46804
GREAT AMERICAN INSURANCE COMPANY
05/10/2024 PCF764
ZURICH AMERICAN INSURANCE COMPANY
11/11/2024 PCF61397
ZURICH AMERICAN INSURANCE COMPANY OF ILLINOIS
11/11/2024 PCF165251

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
RUSSELL G. DELUCA
10/03/2024 PRN233623
KAY LOIS MILLER
02/03/2024 PRN475539
DANIEL H. ROSSEN
03/20/2024 PRN157292

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
KAY LOIS MILLER PRN475539

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
18581307

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 01:41:58 AM