black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

EVERGREEN NATIONAL INDEMNITY COMPANY

INSURANCE COMPANY

License Number:
PCF96999
Status:
First Licensure:
07/21/2003
Cancel Date:
None
Renewal Date:
08/10/2026
NAIC Code:
12750

Street Location:
6150 OAK TREE BLVD STE 440
INDEPENDENCE, OH 44131-6917
Mailing:
6150 OAK TREE BLVD STE 440
INDEPENDENCE, OH 44131-6917
Phone:
+1 (440) 229-3420
Fax:
+1 (440) 229-3421
Email:
regulatory@evergreen-national.com

History

License Type Start Date End Date
INSURANCE COMPANY 07/21/2003 08/10/2026

Employee

Name Issue Date License Number Expiration Date Cancel Date
TIMOTHY M. AYER
08/15/2003 PRN47349
JULIE K. BOWERS
12/09/2008 PRN151970
DEPOSIT CHOICE LLC
01/16/2019 AGN181200
DEREK JAMES ELSTON
06/21/2017 PRN276099
AMBER ENGEL
07/10/2019 PRN302804
EVERGREEN/UNI LLC
11/08/2022 AGN230440
JANICE MARIE FENNELL
06/21/2017 PRN54768
HANNAH ELIZABETH FRANCIS
12/21/2018 PRN292716
ANN BAKER HAMBY
03/27/2019 PRN327302
MICHAEL JOHN HERROD
08/29/2011 PRN110107
MECHELLE LARKIN
05/03/2019 PRN266500
KAREN MARIE LOCONTI-DIAZ
05/18/2005 PRN81884
KATHY MAIR
05/03/2019 PRN229631
JAMES IRWIN MOORE
05/05/2005 PRN48761
JEREMY POLK
03/16/2020 PRN251486
JEREMY C. ROSE
06/21/2017 PRN165541
AUTUMN SCHNEIDER
06/21/2017 PRN285405
MATTHEW TRACY TUCKER
03/19/2014 PRN229846
SUSAN A. WELSH
06/21/2017 PRN193528
SALENA WOOD
06/21/2017 PRN274212

Supervised Entity

None.

Authority

Description Issue Date Termination Date Status
SURETY 07/21/2003 Active

Contacts

Type Contact
PRODUCER LICENSING CONTACT LAUREL ULLMAN BOCKERT
LAUREL ULLMAN BOCKERT
6150 OAK TREE BLVD STE 440
INDEPENDENCE, OH 44131-6917
Phone: +1 (440) 229-3420
Fax: +1 (440) 229-3421
Email: regulatory@evergreen-national.com
SERVICE OF PROCESS CT CORPORATION SYSTEM
128 STATE ST # 3
AUGUSTA, ME 04330-5630
Phone: +1 (855) 316-8944
Email: info@ctadvantage.com

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN)

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: 06/23/2025 07:19:05 PM