black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

DERRICK JEROME HOLLEY

PRODUCER NON-RESIDENT

License Number:
PRN480728
Status:
First Licensure:
04/03/2024
Cancel Date:
None

Mailing:
BOSTON, MA 02116
Phone:
+1 (877) 564-4772
Email:
derrick.holley@libertymutual.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 04/03/2024

Agency

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN FAMILY CONNECT INSURANCE AGENCY INC
02/13/2026 AGN121078

Employer

Name Issue Date License Number Expiration Date Cancel Date
BRISTOL WEST INSURANCE COMPANY
03/03/2026 PCF78370
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MICHIGAN
03/03/2026 PCF445
HOMESITE INSURANCE COMPANY OF THE MIDWEST
11/24/2025 PCF116371
LIBERTY MUTUAL INSURANCE COMPANY
06/10/2024 PCF331 10/08/2024
MIDVALE INDEMNITY COMPANY
11/24/2025 PCF79410
PROGRESSIVE NORTHWESTERN INSURANCE COMPANY
02/27/2026 PCF27738

Authority

Description Issue Date Termination Date Status
PERSONAL LINES 04/03/2024 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
20853645

Other Addresses

Address Type
423 4TH ST #691
JASPER, CO 81144
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: 04/02/2026 07:31:05 AM