black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

MAI TAI ASSOC INC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN189742
Status:
First Licensure:
05/07/2011
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
126 WESTERN AVE
PO BOX 8075
LYNN, MA 01904-0075
Mailing:
PO BOX 8075
LYNN, MA 01904-0075
Phone:
+1 (781) 581-3685
Fax:
+1 (781) 596-8610
Email:
doug@maitaiassociates.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 05/07/2011 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN ECONOMY INSURANCE COMPANY
05/16/2023 PCF363
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MICHIGAN
08/31/2011 PCF445
PHENIX MUTUAL FIRE INSURANCE COMPANY
05/09/2011 PCF554 03/28/2024
SAFECO NATIONAL INSURANCE COMPANY
03/26/2021 PCF248658 11/10/2023

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
DOUGLAS WALTER DODGE
05/07/2011 PRN124145

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
DOUGLAS WALTER DODGE PRN124145

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
16180715

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: 05/25/2025 06:10:47 AM