black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

EVERGREEN/UNI LLC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN230440
Status:
First Licensure:
03/20/2014
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
6150 OAK TREE BLVD STE 440
INDEPENDENCE, OH 44131-6917
Mailing:
6150 OAK TREE BLVD STE 440
INDEPENDENCE, OH 44131-6917
Phone:
+1 (864) 626-5592
Fax:
+1 (440) 229-3421
Email:
kathy.kelleysmith@assuredpartners.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 10/12/2022 04/01/2027
*** NOT ACTIVE *** 07/01/2021 10/11/2022
NON-RESIDENT PRODUCER AGENCY 03/20/2014 06/30/2021

Employer

Name Issue Date License Number Expiration Date Cancel Date
ARCH INSURANCE COMPANY
10/28/2022 PCF62719
BOND SAFEGUARD INSURANCE COMPANY
12/09/2019 PCF106603 07/01/2021
ENDURANCE ASSURANCE CORPORATION
12/09/2019 PCF170128 07/01/2021
EVERGREEN NATIONAL INDEMNITY COMPANY
03/24/2014 PCF96999 07/01/2021
EVERGREEN NATIONAL INDEMNITY COMPANY
11/08/2022 PCF96999
FEDERAL INSURANCE COMPANY
11/04/2022 PCF439
LEXON INSURANCE COMPANY
12/09/2019 PCF109668 07/01/2021
OHIO INDEMNITY COMPANY
12/20/2022 PCF31777
PACIFIC INDEMNITY COMPANY
11/04/2022 PCF547
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
08/20/2024 PCF974
VIGILANT INSURANCE COMPANY
11/04/2022 PCF613
WESTCHESTER FIRE INSURANCE COMPANY
11/04/2022 PCF177973

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
MATTHEW TRACY TUCKER
10/12/2022 PRN229846

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
MATTHEW TRACY TUCKER PRN229846

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
17211821

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: 05/13/2025 06:21:57 PM