black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

ACRISURE MID-ATLANTIC XS PROGRAM INSURANCE AGENCY, LLC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN175070
Status:
First Licensure:
02/19/2010
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
100 OTTAWA AVE SW
GRAND RAPIDS, MI 49503-5087
Mailing:
PO BOX 1788
GRAND RAPIDS, MI 49501-1788
Phone:
+1 (703) 739-2470
Fax:
+1 (703) 739-0761
Email:
insurancelicensing@acrisure.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 02/19/2010 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
GREAT AMERICAN INSURANCE COMPANY
01/08/2015 PCF764
HDI GLOBAL INSURANCE COMPANY
08/09/2023 PCF167923
MOUNT VERNON FIRE INSURANCE COMPANY
07/07/2022 PCF83792
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
06/17/2016 PCF974 07/11/2017

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
LAURIE SUMMERS COLEMAN
02/19/2010 PRN174253

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
LAURIE SUMMERS COLEMAN PRN174253

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
7114514

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: 06/23/2025 06:28:21 PM