Agency Information

ACRISURE MID-ATLANTIC XS PROGRAM INS AGENCY, LLC

Address:

2750 KILLARNEY DR STE 202

WOODBRIDGE, VA 22192-4124

Phone

703-739-2470

URL:

Email:

insurancelicensing@acrisure.com

National Producer Number:

7114514

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	692130	03/31/2010	Active	03/31/2010	03/31/2025
Non-Res. Surplus Lines Broker	692131	03/31/2010	Active	03/31/2010	03/31/2025

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	03/31/2010	Active	03/31/2010
Property	03/31/2010	Active	03/31/2010
Surplus Lines	03/31/2010	Active	08/14/2014

Company Name	Appointment Type	Status	Active Date
288
GREAT AMERICAN INSURANCE COMPANY	Casualty	Active	01/08/2015
	Property	Active	01/08/2015
1214
Company Name	Appointment Type	Status	Active Date
HDI GLOBAL INSURANCE COMPANY	Casualty	Active	08/09/2023
	Property	Active	08/09/2023

row(s) 1 - 4 of 4

Name	Association Type	Agent	Begin Date	End Date
LAURIE SUMMERS COLEMAN	Designated Resp Lic Prdcr	Yes	04/29/2020	-

1 - 1