Individual Information

ROBERT D ROTH

Address:

NORTHBROOK, IL 60062-4517

Status:

Active

Email:

rob.roth@assuredpartners.com

Date:

07/22/2022

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3814318	07/22/2022	Active	07/22/2022	07/31/2025
Non-Res. Surplus Lines Broker	3816471	07/28/2022	Active	07/28/2022	07/31/2025

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	07/22/2022	Active	07/22/2022
Health	02/11/2023	Active	02/11/2023
Life	02/11/2023	Active	02/11/2023
Limited Portable Electronics	07/22/2022	Active	07/22/2022
Property	07/22/2022	Active	07/22/2022
Surplus Lines	07/28/2022	Active	07/28/2022

Company Name	Appointment Type	Status	Active Date
1054
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA	Casualty	Active	05/01/2023
	Property	Active	05/01/2023

row(s) 1 - 2 of 2

Organization	Association Type	Type	Beg dte	End dte
BRECKENRIDGE INSURANCE SERVICES, LLC	Designated Resp Lic Prdcr	Agency	12/20/2024	-
CHAMBER INSURANCE AGENCY SERVICES LLC	Designated Resp Lic Prdcr	Agency	08/18/2022	-
ACCRETIVE SPECIALTY INSURANCE SOLUTIONS, LLC	Designated Resp Lic Prdcr	Agency	12/12/2022	-
ACCRETIVE GENERAL AGENCY, LLC	Designated Resp Lic Prdcr	Agency	01/17/2023	-
SYNERGY PROFESSIONAL ASSOC INC	Designated Resp Lic Prdcr	Agency	07/25/2022	-

1 - 5