black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

SAFEHOLD SPECIAL RISK INC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN141202
Status:
Active
First Licensure:
06/20/2007
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
222 S RIVERSIDE PLZ STE 900
CHICAGO, IL 60606-5975
Mailing:
601 UNION ST STE 1000
SEATTLE, WA 98101-4064
Phone:
+1 (206) 676-7466
Fax:
+1 (312) 658-4100
Email:
licensing@usi.com

History
License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 06/20/2007 04/01/2027

Employer
Name Issue Date License Number Expiration Date Cancel Date
ACE AMERICAN INSURANCE COMPANY
 04/15/2008 PCF640
ACE FIRE UNDERWRITERS INSURANCE COMPANY
 04/15/2008 PCF43 02/15/2013
ACE FIRE UNDERWRITERS INSURANCE COMPANY
 06/30/2014 PCF43
ACE PROPERTY & CASUALTY INSURANCE COMPANY
 04/15/2008 PCF44 02/15/2013
ACE PROPERTY & CASUALTY INSURANCE COMPANY
 06/30/2014 PCF44
ALLMERICA FINANCIAL ALLIANCE INSURANCE COMPANY
 12/10/2009 PCF75617 10/27/2015
ALLMERICA FINANCIAL BENEFIT INSURANCE COMPANY
 12/10/2009 PCF145893 09/25/2015
AMERICAN ALTERNATIVE INSURANCE CORP
 01/22/2014 PCF381 10/31/2016
AMERICAN BANKERS INSURANCE COMPANY OF FLORIDA
 03/04/2014 PCF357 10/09/2015
AMERICAN CASUALTY COMPANY OF READING PENNSYLVANIA
 03/13/2012 PCF358 06/08/2012
AMERICAN FAMILY HOME INSURANCE
 01/22/2014 PCF201383 11/02/2016
AMERICAN GUARANTEE & LIABILITY INSURANCE COMPANY
 02/24/2010 PCF366
AMERICAN MODERN HOME INSURANCE COMPANY
 08/19/2014 PCF808 06/10/2015
AMERICAN MODERN SELECT INSURANCE COMPANY
 08/19/2014 PCF123448 06/10/2015
AMERICAN SOUTHERN HOME INSURANCE COMPANY
 01/22/2014 PCF138324 11/02/2016
AMERICAN ZURICH INSURANCE COMPANY
 06/11/2008 PCF914
AMTRUST INSURANCE COMPANY
 09/20/2022 PCF260762
ASPEN AMERICAN INSURANCE COMPANY
 09/24/2015 PCF43292 06/28/2017
ASSURANCE COMPANY OF AMERICA
 06/11/2008 PCF651 02/02/2015
BANKERS STANDARD INSURANCE COMPANY
 06/30/2014 PCF152165
BERKLEY LIFE AND HEALTH INSURANCE COMPANY
 08/08/2018 LHF14
THE CHARTER OAK FIRE INSURANCE COMPANY
 11/08/2010 PCF403
CITIZENS INSURANCE COMPANY OF AMERICA
 12/10/2009 PCF937 10/27/2015
CONTINENTAL CASUALTY COMPANY
 03/13/2012 PCF420 06/08/2012
CONTINENTAL INSURANCE COMPANY
 03/13/2012 PCF782 06/08/2012
EMPLOYERS ASSURANCE COMPANY
 03/31/2022 PCF285638 03/21/2024
EMPLOYERS COMPENSATION INSURANCE COMPANY
 03/31/2022 PCF285639 03/21/2024
EMPLOYERS INSURANCE COMPANY OF WAUSAU
 03/19/2010 PCF434
EMPLOYERS PREFERRED INSURANCE COMPANY
 03/31/2022 PCF285637 03/21/2024
EVEREST DENALI INSURANCE COMPANY
 12/25/2020 PCF289213 01/30/2025
EVEREST NATIONAL INSURANCE COMPANY
 12/25/2020 PCF99574 01/30/2025
EVEREST PREMIER INSURANCE COMPANY
 08/03/2021 PCF289214 01/30/2025
FARMINGTON CASUALTY COMPANY
 11/08/2010 PCF995 07/02/2014
FIRST LIBERTY INSURANCE CORPORATION
 03/19/2010 PCF31779
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MICHIGAN
 11/23/2010 PCF445 06/26/2018
FOREMOST PROPERTY AND CASUALTY INSURANCE COMPANY
 04/19/2013 PCF37337 06/10/2020
FOREMOST SIGNATURE INSURANCE COMPANY
 04/19/2013 PCF176307 06/10/2020
GRANITE STATE INSURANCE COMPANY
 09/25/2014 PCF452 04/03/2025
GREAT AMERICAN ALLIANCE INSURANCE COMPANY
 06/19/2009 PCF46804 04/03/2025
GREAT AMERICAN ASSURANCE COMPANY
 06/19/2009 PCF702 04/03/2025
GREAT AMERICAN INSURANCE COMPANY
 06/19/2009 PCF764 04/03/2025
GREAT AMERICAN INSURANCE COMPANY OF NEW YORK
 06/19/2009 PCF326 04/03/2025
GREAT AMERICAN SECURITY INS CO
 09/10/2010 PCF47084 04/03/2025
THE HANOVER INSURANCE COMPANY
 12/10/2009 PCF712 10/27/2015
HARLEYSVILLE INSURANCE COMPANY
 04/13/2009 PCF129870 09/29/2011
HARLEYSVILLE MUTUAL INSURANCE COMPANY
 04/13/2009 PCF74622 09/29/2011
HARLEYSVILLE PREFERRED INSURANCE COMPANY
 04/13/2009 PCF128998 09/29/2011
HARLEYSVILLE WORCESTER INSURANCE COMPANY
 04/13/2009 PCF908 09/29/2011
HISCOX INSURANCE COMPANY INC
 02/05/2014 PCF985
HOLYOKE MUTUAL INSURANCE COMPANY IN SALEM
 02/28/2009 PCF472 05/25/2015
ILLINOIS NATIONAL INSURANCE COMPANY
 09/25/2014 PCF53254 04/03/2025
INDEMNITY INSURANCE COMPANY OF NORTH AMERICA
 07/12/2008 PCF50104 02/15/2013
INDEMNITY INSURANCE COMPANY OF NORTH AMERICA
 06/30/2014 PCF50104
LIBERTY INSURANCE CORPORATION
 03/19/2010 PCF999
LIBERTY MUTUAL FIRE INSURANCE COMPANY
 03/19/2010 PCF330
LIBERTY MUTUAL INSURANCE COMPANY
 03/19/2010 PCF331
LM INSURANCE CORPORATION
 03/19/2010 PCF31778
MANUFACTURERS ALLIANCE INSURANCE COMPANY
 11/29/2016 PCF82408
MARKEL AMERICAN INSURANCE COMPANY
 05/28/2015 PCF48506
MARYLAND CASUALTY COMPANY
 06/11/2008 PCF500 02/02/2015
MASSACHUSETTS BAY INSURANCE COMPANY
 12/10/2009 PCF505 05/09/2025
MEDICAL PROTECTIVE COMPANY (THE)
 07/16/2020 PCF47861
MIDDLESEX MUTUAL ASSURANCE COMPANY
 02/28/2009 PCF844 05/25/2015
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
 03/13/2012 PCF523 06/08/2012
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA
 12/01/2015 PCF527 04/03/2025
NEW HAMPSHIRE INSURANCE COMPANY
 09/25/2014 PCF531 04/03/2025
NEW YORK MARINE AND GENERAL INSURANCE COMPANY
 10/18/2016 PCF36395 01/04/2023
NORTH POINTE INSURANCE COMPANY
 01/23/2012 PCF108068 03/03/2017
NORTHERN INSURANCE COMPANY OF NEW YORK
 06/11/2008 PCF501 02/03/2015
NOVA CASUALTY COMPANY
 04/30/2010 PCF120494 05/09/2025
PACIFIC EMPLOYERS INSURANCE COMPANY
 07/12/2008 PCF546 02/15/2013
PACIFIC EMPLOYERS INSURANCE COMPANY
 06/30/2014 PCF546
PENNSYLVANIA MANUFACTURERS INDEMNITY COMPANY
 11/29/2016 PCF82412
PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY
 11/29/2016 PCF82421
PHILADELPHIA INDEMNITY INSURANCE COMPANY
 03/25/2019 PCF46041
THE PHOENIX INSURANCE COMPANY
 11/08/2010 PCF557 07/02/2014
PRAETORIAN INSURANCE COMPANY
 01/23/2012 PCF68207
QBE INSURANCE CORPORATION
 01/23/2012 PCF82307
RURAL COMMUNITY INSURANCE COMPANY
 04/20/2009 PCF122778 04/08/2017
SECURITY NATIONAL INSURANCE COMPANY
 09/20/2017 PCF189490
SEQUOIA INSURANCE COMPANY
 04/23/2020 PCF128467
SOUTHWEST MARINE AND GENERAL INSURANCE COMPANY
 10/31/2016 PCF223349 12/15/2016
ST. PAUL FIRE AND MARINE INSURANCE COMPANY
 10/14/2011 PCF575 07/02/2014
THE STANDARD FIRE INSURANCE COMPANY
 11/08/2010 PCF584 07/02/2014
STAR INSURANCE COMPANY
 03/14/2013 PCF59785 06/02/2014
STARNET INSURANCE COMPANY
 08/08/2018 PCF103936
TECHNOLOGY INSURANCE COMPANY INC
 09/20/2017 PCF136874
TRANSPORTATION INSURANCE COMPANY
 03/13/2012 PCF601 06/08/2012
TRAVELERS CASUALTY AND SURETY COMPANY
 11/08/2010 PCF348 07/08/2020
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
 05/18/2010 PCF974 07/11/2017
TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA
 11/08/2010 PCF935 07/02/2014
TRAVELERS COMMERCIAL CASUALTY COMPANY
 11/08/2010 PCF83507 07/02/2014
THE TRAVELERS INDEMNITY COMPANY OF AMERICA
 11/08/2010 PCF585 07/02/2014
THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT
 11/08/2010 PCF435 08/14/2023
THE TRAVELERS INDEMNITY COMPANY
 11/08/2010 PCF602 07/02/2014
TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
 11/08/2010 PCF711 07/02/2014
VALLEY FORGE INSURANCE COMPANY
 03/13/2012 PCF612 06/08/2012
WATFORD INSURANCE COMPANY
 02/13/2019 PCF92579 01/31/2025
WAUSAU BUSINESS INSURANCE COMPANY
 03/19/2010 PCF47449 03/30/2015
WAUSAU UNDERWRITERS INSURANCE COMPANY
 03/19/2010 PCF833 08/27/2015
WESCO INSURANCE COMPANY
 09/20/2017 PCF49735
WESTCHESTER FIRE INSURANCE COMPANY
 09/16/2015 PCF177973
ZURICH AMERICAN INSURANCE COMPANY
 02/24/2010 PCF61397
ZURICH AMERICAN INSURANCE COMPANY OF ILLINOIS
 02/24/2010 PCF165251

Affiliated Agent
Name Issue Date License Number Expiration Date Cancel Date
ROBERT LEROY ALLEN
 10/25/2023 PRN414261
CARISSA ATENCIO
 12/13/2024 PRN502563
SHAWN BECKLER
 01/17/2013 PRN163427
COREY CASH
 02/24/2009 PRN66910
DENISE L. CORRIVEAU
 10/13/2020 PRN363036
ANDREW JOHAN DAHLIN
 08/15/2024 PRN476653
NICHOLAS J. DALESSIO
 01/06/2022 PRN103219
DONNA M. DECAREAU
 02/16/2011 PRN187299
DAVID FOWLER
 06/17/2024 PRN356272
ANGELIC C. HATHAWAY
 10/25/2023 PRN229989
HUBERT LUCAS
 06/26/2023 PRN231849
JOHN PAULK
 06/28/2013 PRN218113
JOHN IRVINE PAULK JR
 09/16/2014 PRN49710
LORI J. POTTER
 11/03/2010 PRN184190
ANGELA E. REED
 04/18/2024 PRN187369
CHERYN R. SCHREIBER
 02/02/2011 PRN186869
DINAMARIE SERRANO
 10/28/2015 PRN145046
PETER S. STEVENS
 11/14/2023 PRN273448
AARON STILTNER
 08/22/2014 PRN237079
CHERYL A. THIM
 10/28/2015 PRR59455
KRISTINA TIBBETTS
 04/18/2024 PRN322774
KHANSA YOUSSUF
 02/17/2023 PRN385430

Branch Office
Name Issue Date License Number Expiration Date Cancel Date
SAFEHOLD SPECIAL RICK INC (SEATTLE WA)
 12/04/2018 BRN322423
SAFEHOLD SPECIAL RISK INC (CARROLLTON GA)
 02/11/2014 BRN228943
SAFEHOLD SPECIAL RISK INC (FLORHAM PARK NJ)
 10/30/2018 BRN320443
SAFEHOLD SPECIAL RISK INC (HOUSTON TX)
 09/28/2018 BRN318058
SAFEHOLD SPECIAL RISK INC (LAKEWOOD CO)
 07/05/2012 BRN205068
SAFEHOLD SPECIAL RISK INC (PORTLAND OR)
 07/05/2012 BRN205070
SAFEHOLD SPECIAL RISK INC (PORTSMOUTH NH)
 01/24/2013 BRN212979
SAFEHOLD SPECIAL RISK INC (RANCHO CORDOVA CA)
 01/27/2016 BRN263446

Supervised Entity

None.

Responsible Individual
Name License Number
JOHN PAULK PRN218113

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
9142974

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: 05/19/2025 08:06:21 AM