black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

TERRY L GREEN & ASSOC INC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN155743
Status:
First Licensure:
07/12/2008
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
3100 FIVE FORKS TRICKUM RD SW STE 101
LILBURN, GA 30047-1887
Mailing:
3100 FIVE FORKS TRICKUM RD SW STE 101
LILBURN, GA 30047-1887
Phone:
+1 (678) 205-8040
Fax:
+1 (770) 978-2780
Email:
info@esportsinsurance.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 07/12/2008 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
AEGIS SECURITY INSURANCE COMPANY
02/27/2019 PCF49874 12/13/2023
AXIS INSURANCE COMPANY
07/01/2010 PCF134278
BERKLEY LIFE AND HEALTH INSURANCE COMPANY
11/06/2015 LHF14
GREAT AMERICAN INSURANCE COMPANY
05/05/2015 PCF764
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA
11/16/2010 PCF527
NATIONWIDE LIFE INSURANCE COMPANY
11/10/2008 LHF29 11/03/2010
NATIONWIDE LIFE INSURANCE COMPANY
03/24/2015 LHF29
NATIONWIDE MUTUAL INSURANCE COMPANY
11/10/2008 PCF32 11/03/2010
NATIONWIDE MUTUAL INSURANCE COMPANY
03/24/2015 PCF32
STARNET INSURANCE COMPANY
11/06/2015 PCF103936
STARR INDEMNITY & LIABILITY COMPANY
04/04/2019 PCF1010 08/12/2019
UNITED STATES FIRE INSURANCE COMPANY
03/10/2014 PCF101256

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
RHONDA LYNNE CROOK
07/01/2017 PRN289235
TERRY L. GREEN
07/12/2008 PRN101504
RONALD LETSON
01/03/2025 PRN504707
EARL RANDY MARCUS
11/27/2018 PRN322053

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
TERRY L. GREEN PRN101504

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
8600344

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: 06/07/2025 04:17:17 PM