Individual Information

JEROD BLAKESTAD

Address:

PARK CITY, UT 84060-7618

Status:

Active

Email:

jerod.blakestad@monoline.com

Date:

04/17/2014

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	947651	04/17/2014	Active	04/17/2014	04/30/2026
Non-Res. Surplus Lines Broker	3203770	11/15/2016	Active	11/15/2016	11/30/2025

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	04/17/2014	Active	04/17/2014
Property	04/17/2014	Active	04/17/2014
Surplus Lines	11/15/2016	Active	11/15/2016

Company Name	Appointment Type	Status	Active Date
113
AIG PROPERTY CASUALTY COMPANY	Casualty	Active	09/19/2023
	Property	Active	09/19/2023
128831
Company Name	Appointment Type	Status	Active Date
CONCERT INSURANCE COMPANY	Casualty	Active	07/31/2023
	Property	Active	07/31/2023
1776
Company Name	Appointment Type	Status	Active Date
OHIO SECURITY INSURANCE COMPANY	Casualty	Active	12/06/2022
	Property	Active	12/06/2022

row(s) 1 - 6 of 6

Organization	Association Type	Type	Beg dte	End dte
OTRI INSURANCE SERVICES, LLC	Designated Resp Lic Prdcr	Agency	09/17/2020	-
MONOLINE, INC	Designated Resp Lic Prdcr	Agency	12/05/2022	-

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