Individual Information

MARK A DI PERNO

Address:

LIGHTHOUSE POINT, FL 33064-8510

Status:

Active

Email:

mark@sportsinsurance.com

Date:

07/12/2005

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	205934	07/12/2005	Active	07/12/2005	07/31/2026
Non-Res. Surplus Lines Broker	3457246	07/22/2019	Active	07/22/2019	07/31/2025

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	07/12/2005	Active	07/12/2005
Health	07/12/2005	Active	07/12/2005
Life	07/19/2019	Active	07/19/2019
Personal Lines	07/12/2005	Active	07/12/2005
Property	07/19/2019	Active	07/19/2019
Surplus Lines	07/22/2019	Active	07/22/2019

Company Name	Appointment Type	Status	Active Date
1163
AXIS INSURANCE COMPANY	Health	Active	11/02/2020
1786
Company Name	Appointment Type	Status	Active Date
COLONY SPECIALTY INSURANCE COMPANY	Casualty	Active	03/24/2020
	Property	Active	03/24/2020
288
Company Name	Appointment Type	Status	Active Date
GREAT AMERICAN INSURANCE COMPANY	Casualty	Active	12/02/2021
	Property	Active	12/02/2021
692
Company Name	Appointment Type	Status	Active Date
UNITED STATES FIRE INSURANCE COMPANY	Casualty	Active	10/30/2014
	Health	Active	10/30/2014

row(s) 1 - 7 of 7

Organization	Association Type	Type	Beg dte	End dte
SPORT AND EVENT INSURANCE SOLUTIONS, INC	Designated Resp Lic Prdcr	Agency	11/28/2020	-
SPORTS AND SPECIAL EVENT INS AGENCY	Designated Resp Lic Prdcr	Agency	11/28/2020	-

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