black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

TAWAS BAY INS AGENCY LLC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN158620
Status:
First Licensure:
10/02/2008
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
108 W STATE ST
EAST TAWAS, MI 48730-1229
Mailing:
PO BOX 432
EAST TAWAS, MI 48730-0432
Phone:
+1 (989) 345-0200
Fax:
+1 (989) 345-0232
Email:
michelle@dieboldinsurance.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 11/13/2015 04/01/2027
*** NOT ACTIVE *** 07/01/2013 11/12/2015
NON-RESIDENT PRODUCER AGENCY 10/02/2008 06/30/2013

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN PROGRESSIVE LIFE & HEALTH INS COMPANY OF NEW YORK
12/23/2023 LHF374 02/28/2025
THE CINCINNATI LIFE INSURANCE COMPANY
12/14/2015 LHF75044
INDEPENDENCE AMERICAN INSURANCE COMPANY
01/18/2023 PCF86149
MAINE DENTAL SERVICE CORP
11/01/2008 NPD29330 07/01/2013
MAINE DENTAL SERVICE CORP
02/15/2022 NPD29330
PROVIDENT LIFE & ACCIDENT INSURANCE COMPANY
12/03/2015 LHF250
TRAVELERS CASUALTY AND SURETY COMPANY
08/29/2019 PCF348
UNUM LIFE INSURANCE COMPANY OF AMERICA
12/03/2015 LHD145
VISION SERVICE PLAN INSURANCE COMPANY
05/12/2016 LHF47545
WELLCARE OF MAINE, INC.
12/23/2023 HMD305081 02/10/2025
WELLCARE PRESCRIPTION INSURANCE INC
12/23/2023 LHF121869 02/28/2025

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
DANIEL ELLIOTT
03/11/2025 PRN446398
KEVIN A. ELLIOTT
11/13/2015 PRN155290

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
DANIEL ELLIOTT PRN446398

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
958329

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: 10/22/2025 04:48:43 PM