black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

KELLY BENEFITS WORKERS COMPENSATION, INC.

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN138198
Status:
First Licensure:
03/28/2007
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
1 KELLY WAY
SPARKS, MD 21152-9484
Mailing:
1 KELLY WAY
SPARKS, MD 21152-9484
Phone:
+1 (410) 891-3030
Fax:
+1 (410) 527-3470
Email:
mdonatelli@kellybenefits.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 03/28/2007 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
EMPLOYERS ASSURANCE COMPANY
05/07/2024 PCF285638
EMPLOYERS COMPENSATION INSURANCE COMPANY
05/07/2024 PCF285639
EMPLOYERS PREFERRED INSURANCE COMPANY
05/07/2024 PCF285637

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
DAVID E. KELLY
03/28/2007 PRN76833

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
DAVID E. KELLY PRN76833

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
9100512

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: 06/21/2025 03:09:03 PM