black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

OBI NATIONAL INSURANCE COMPANY

INSURANCE COMPANY

License Number:
PCF214724
Status:
First Licensure:
03/20/2013
Cancel Date:
None
Renewal Date:
08/10/2025
NAIC Code:
14190

Street Location:
600 N 2ND ST STE 401
HARRISBURG, PA 17101-1071
Mailing:
BRIDGET A DELANEY
605 HIGHWAY 169 N STE 800
PLYMOUTH, MN 55441-6533
Phone:
+1 (952) 852-0476
Email:
regulatorychange@intactinsurance.com

History

License Type Start Date End Date
INSURANCE COMPANY 03/20/2013 08/10/2025

Employee

Name Issue Date License Number Expiration Date Cancel Date
ADMIRALTY INS AGENCY INC
10/04/2021 AGN229295
ASSUREDPARTNERS NL LLC
07/06/2021 AGN193825
WILLIAM CHARLES BURKE III
02/18/2020 PRN51054
MICHAEL PAUL GINGRICH
07/06/2021 PRN157115
MARIE ADELE HAYWARD
10/05/2021 PRN153761
GREGORY J. HORUN
09/11/2020 PRN162804
INNOVATION GROWTH PARTNERS SPECIALTY, LLC
03/29/2022 AGN40720
JOHN PAULK
04/08/2024 PRN218113
JASON M. WIESELMAN
09/14/2020 PRN176080
WILLIAM C BURKE JR INSURANCE AGENCY INC
02/18/2020 AGN51433

Supervised Entity

None.

Authority

Description Issue Date Termination Date Status
WORKERS COMPENSATION 03/20/2013 Active

Contacts

Type Contact
PRODUCER LICENSING CONTACT DONNA WALSH
DONNA WALSH
150 ROYALL ST STE 100
CANTON, MA 02021-1054
Phone: +1 (781) 332-8027
Fax: +1 (888) 228-6922
Email: agencylicensing@intactinsurance.com
WORKERS COMPENSATION CLAIMS CINDY VAN EYLL
OBI NATIONAL INSURANCE COMPANY
605 HIGHWAY 169 N STE 800
PLYMOUTH, MN 55441-6533
Phone: +1 (952) 852-0828
Fax: +1 (866) 639-0437
Email: cvaneyll@intactinsurance.com
SERVICE OF PROCESS CORPORATION SERVICE COMPANY
45 MEMORIAL CIR
AUGUSTA, ME 04330-6400
Phone: +1 (800) 927-9800
Fax: +1 (302) 636-5454
Email: sop@cscglobal.com

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN)

Other Phone Numbers

Phone Number Type
+1 (800) 677-3394 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: 05/14/2025 07:26:50 PM