black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

AMICA GENERAL AGENCY LLC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN33047
Status:
First Licensure:
06/24/1991
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
ONE HUNDRED AMICA WAY
LINCOLN, RI 02865
Mailing:
PO BOX 6008
PROVIDENCE, RI 02940-6008
Phone:
+1 (800) 234-5433
Fax:
+1 (401) 334-6518
Email:
liferegulatoryservices@amica.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 06/24/1991 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN MODERN HOME INSURANCE COMPANY
03/01/2001 PCF808 10/28/2021
AMERICAN MODERN HOME INSURANCE COMPANY
04/25/2023 PCF808
AMERICAN MODERN PROPERTY & CASUALTY INSURANCE COMPANY
05/16/2018 PCF234561
AMERICAN MODERN SELECT INSURANCE COMPANY
08/01/2007 PCF123448 10/28/2021
BRISTOL WEST INSURANCE COMPANY
07/14/2022 PCF78370
C M LIFE INSURANCE COMPANY
06/24/1991 LHF906 02/18/2020
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MICHIGAN
07/18/2001 PCF445
JEWELERS MUTUAL INSURANCE COMPANY, SI
09/30/2002 PCF773
JOHN ALDEN LIFE INSURANCE COMPANY
12/31/2004 LHF724 11/03/2005
JOHN HANCOCK LIFE INSURANCE COMPANY
02/22/1995 LHF264 01/08/2010
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY
06/24/1991 LHF17 02/18/2020
THE PAUL REVERE LIFE INSURANCE COMPANY
02/24/1992 LHF240 12/11/2002
PROGRESSIVE CASUALTY INSURANCE COMPANY
06/11/1998 PCF637 03/29/2006
PROGRESSIVE NORTHERN INSURANCE COMPANY
07/28/1999 PCF51006
PROGRESSIVE NORTHWESTERN INSURANCE COMPANY
06/11/1998 PCF27738
PROVIDENT LIFE & ACCIDENT INSURANCE COMPANY
12/13/1997 LHF250 03/29/2007
STILLWATER PROPERTY AND CASUALTY INSURANCE COMPANY
01/24/2008 PCF988 11/05/2014
TIME INSURANCE COMPANY
08/25/1994 LHF276 09/20/2005
UNITED FINANCIAL CASUALTY COMPANY
08/11/2006 PCF61704 03/31/2012
UNUM LIFE INSURANCE COMPANY OF AMERICA
07/24/2000 LHD145 03/29/2007
WRIGHT NATIONAL FLOOD INSURANCE COMPANY
01/01/2017 PCF190582

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
JOSEPH DAVID AGNOLI
12/29/2017 PRN211603
JEANNETTE ELVIRA ALQUICIRA
08/02/2017 PRN226213
MARIA DE LOS ANGELES BAKER
05/29/2019 PRN329873
NINA BEAVERS
02/18/2022 PRN409664
SHANNON MARIE BOYLE
09/09/2025 PRN377324
DEIDRA BROWN
09/08/2017 PRN221828
ERICA N. CALISE
12/07/2022 PRN248591
SUSAN P. CALNAN
12/17/2020 PRR282021
JUDY ANN CARLSON
08/02/2017 PRN211643
SERGIO A. CASTRO
09/08/2017 PRN273069
KAREN D. CHAMBERLAIN
10/22/2019 PRN338195
MARCIA B. CHAPDELAINE
10/22/2019 PRN337413
CHERHARA C. CHARLES
06/04/2020 PRN352482
TRACI L. CHASE
10/22/2019 PRN337415
KAREN A. CHIASSON
09/01/2006 PRR130329
KATHERINE COLEMAN
04/07/2021 PRN375697
DAWN MARIE COLLINS
07/17/2018 PRN180223
STEFANIE CORDEIRO
10/22/2019 PRN337416
JOHN J. COSTELLO
08/02/2017 PRN211744
MARIA LUISA RODIS CRUZ
08/02/2017 PRN277443
MICHELLE B. DALTON
10/22/2019 PRN337509
LISA LYNN DANIELS
06/09/2006 PRR59786
FELICIA DAUGHRATY
10/22/2019 PRN337402
MEGAN MARIE DELISLE
10/22/2019 PRN337418
MICHELLE D. DINEZZA
09/28/2007 PRN144086
COLLEEN DUNN
09/14/2021 PRN392137
LILLIAN AVA ELLIOTT
09/14/2021 PRN392133
DAVID J. FAIOLA
02/15/2023 PRN261146
JACQUILYN M. FLACK
10/22/2019 PRN337426
GAIL M. FLAMAND
10/22/2019 PRN338197
DANIELLE FORTIN
01/20/2023 PRN440469
NATHANIEL E. GAUTIER
10/22/2019 PRN337510
DEANNA M. GOLOTTO
12/11/2018 PRN72394
RACHAEL ALEXIS GUYOTTE
05/25/2023 PRN437144
JONATHAN E. HALL
10/22/2019 PRN337431
JENNIFER L. HATCH
10/22/2019 PRN338206
SUSAN M. HESSE
01/28/1998 PRN36968
KAREN W. HILL
05/08/2002 PRR85215
RAYMOND F. HORNE III
10/22/2019 PRN337554
DEREK HUBER
05/30/2025 PRN172344
DAVID M. IMONDI
07/20/2018 PRN243750
HOLLY JENNESS
10/22/2019 PRN337405
LISA MARIA JOLY
10/22/2019 PRN96169
NATHAN R. JUDD
10/22/2019 PRN337504
ELLIOT P. KASDEN
10/04/2022 PRN211329
NANCY L. KENISON
10/22/2019 PRN337511
KATHERINE M. KNIGHT
08/20/2019 PRN286942
ANNE L. KUSLER
03/26/2007 PRN82865
HEATHER LAIRD
04/07/2021 PRN115017
JOSEPH R. LESSARD
10/22/2019 PRN337420
MELISSA LEWANDOWSKI
06/05/2025 PRN280560
ERIKA L. MACKENZIE
10/03/2025 PRN309673
CASSANDRA MARLAND
10/22/2019 PRN337516
KEVIN L. MAYER
09/08/2017 PRN280678
DOREEN M. MCDONOUGH
10/22/2019 PRN337552
STACY LYNN MCRAE
05/30/2019 PRN331913
JARED TYLER MELENDEZ
12/29/2017 PRN278943
TUON T. MI
10/04/2022 PRN180235
CAROL C. MISSAMORE
12/04/2005 PRN121527
DAWN MARIE NORDBY-GAULIN
07/27/2007 PRN85090
KAREN E. NORMANDIN
12/29/2017 PRN211445
PAMELA PACITTI
06/04/2020 PRN354547
JUDITH M. REMILLARD
10/22/2019 PRN337551
BRIAN A. SALYARDS
10/22/2019 PRN337432
SARAH J. SHANELARIS
09/18/2023 PRN454413
TERRY SLASKE
10/22/2019 PRN337433
BRETANI E. SOLOMON
12/29/2017 PRN279892
JONATHAN JOSEPH SPICOLA
07/20/2018 PRN221367
CHRISTOPHER E. SPURR
12/17/2020 PRR282019
MICHELE B. STROUPE
08/02/2017 PRN212094
EMILY-ANN LEAHY SULLIVAN
12/17/2020 PRR242419
GEORGE V. SWENSON
10/22/2019 PRN337548
CARRIE A. TASKER MILLER
10/22/2019 PRN211313
HAYLEY J. TRASK
10/22/2019 PRN337502
WENDY MARIE VANDERLEEST
06/04/2020 PRN354404
SHERYL OLAVIDEZ VICENTE
01/22/2025 PRN211636
TRACY A. WATTS
07/20/2018 PRN311202
ALECIA J. WELLMAN
07/16/2021 PRN387163
RITA WHITLEY HLAVINKA
10/03/2025 PRN375746
TAYLA DANIELLE WRIGHT
10/22/2019 PRN337549

Branch Office

Name Issue Date License Number Expiration Date Cancel Date
AMICA GENERAL AGENCY LLC (AUSTIN TX)
08/16/2017 BRN291946
AMICA GENERAL AGENCY LLC (HENDERSON NV)
08/16/2017 BRN291947
AMICA GENERAL AGENCY LLC (SOUTH PORTLAND ME)
06/09/2005 BRN114885
AMICA GENERAL AGENCY LLC (SPOKANE VALLEY WA)
06/08/2007 BRN140724

Supervised Entity

None.

Responsible Individual

Name License Number
DEREK HUBER PRN172344

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
654114

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: 10/13/2025 01:03:39 AM