black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

DAVID EDWARD SIEBEKING

PRODUCER NON-RESIDENT

License Number:
PRN109301
Status:
First Licensure:
12/10/2004
Cancel Date:
None

Mailing:
ANDOVER, MA 01810
Phone:
+1 (781) 362-1000
Fax:
+1 (781) 273-3750
Email:
dave.siebeking@jjins.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 12/10/2004

Agency

Name Issue Date License Number Expiration Date Cancel Date
H T BAILEY INSURANCE AGENCY INC
12/10/2004 AGN50308 03/02/2015
H T BAILEY SOUTH INS AGENCY INC
02/11/2011 AGN150025 03/02/2015

Employer

Name Issue Date License Number Expiration Date Cancel Date
ACE AMERICAN INSURANCE COMPANY
07/26/2011 PCF640
ATLANTIC SPECIALTY INSURANCE COMPANY
10/04/2011 PCF104029 12/11/2013
ATLANTIC SPECIALTY INSURANCE COMPANY
03/27/2014 PCF104029 04/22/2015
EMPLOYERS FIRE INSURANCE COMPANY
03/05/2009 PCF41 11/20/2010
GREAT AMERICAN INSURANCE COMPANY
01/31/2011 PCF764 12/27/2018
MOUNT VERNON FIRE INSURANCE COMPANY
10/01/2009 PCF83792
NORTHERN ASSURANCE COMPANY OF AMERICA
11/20/2010 PCF1020 08/01/2013

Authority

Description Issue Date Termination Date Status
CASUALTY 12/10/2004 Active
HEALTH 12/10/2004 Active
LIFE 12/10/2004 Active
PROPERTY 12/10/2004 Active
SURPLUS LINES 12/10/2004 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
5436168

Other Addresses

Address Type
JOHNSON & JOHNSON INC
20 MALL RD
BURLINGTON, MA 01803-4123
Office

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: 01/02/2026 02:34:19 AM