Individual Information

JERRY BOCK SHOCKEY

TUCSON, AZ 85711-7456

Active

licensing@crestins.com

11/19/2014

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3166290	06/22/2016	Active	06/22/2016	06/30/2025
Non-Res. Surplus Lines Broker	1000438	11/19/2014	Active	11/19/2014	11/30/2026

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	06/22/2016	Active	06/22/2016
Health	09/01/2022	Active	09/01/2022
Life	09/01/2022	Active	09/01/2022
Property	06/22/2016	Active	06/22/2016
Surplus Lines	11/19/2014	Active	08/14/2014

Company Name	Appointment Type	Status	Active Date
965
ACUITY A MUTUAL INSURANCE COMPANY	Casualty	Active	10/28/2024
	Property	Active	10/28/2024
12
Company Name	Appointment Type	Status	Active Date
ALL AMERICA INSURANCE COMPANY	Casualty	Active	05/16/2018
	Property	Active	05/16/2018
136
Company Name	Appointment Type	Status	Active Date
CENTRAL INSURANCE COMPANY	Casualty	Active	05/16/2018
	Property	Active	05/16/2018
147790
Company Name	Appointment Type	Status	Active Date
COPPERPOINT GENERAL INSURANCE COMPANY	Casualty	Active	08/12/2020
	Property	Active	08/12/2020
499
Company Name	Appointment Type	Status	Active Date
OLD REPUBLIC INSURANCE COMPANY	Casualty	Active	02/12/2020
	Property	Active	02/12/2020
98012
Company Name	Appointment Type	Status	Active Date
PACIFIC COMPENSATION INSURANCE COMPANY	Casualty	Active	10/23/2024
16140
Company Name	Appointment Type	Status	Active Date
SELECTIVE INSURANCE COMPANY OF AMERICA	Casualty	Active	11/17/2021
	Property	Active	11/17/2021
1488
Company Name	Appointment Type	Status	Active Date
TRAVELERS PROPERTY CASUALTY INSURANCE COMPANY	Casualty	Active	07/10/2020
	Property	Active	07/10/2020
693
Company Name	Appointment Type	Status	Active Date
UNITED STATES LIABILITY INSURANCE COMPANY	Casualty	Active	03/03/2020
	Property	Active	03/03/2020

row(s) 1 - 17 of 17

Organization	Association Type	Type	Beg dte	End dte
CREST INS GROUP LLC	Designated Resp Lic Prdcr	Agency	03/04/2020	-

1 - 1