Agency Information

KAPATOES INSURANCE SERVICES, LLC

725 PRIMERA BLVD

LAKE MARY, FL 32746

888-467-3330

dawn@kisllc.com

2990227

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	3400742	12/12/2018	Active	12/12/2018	12/31/2024

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	12/12/2018	Active	12/12/2018
Property	12/12/2018	Active	12/12/2018

Company Name	Appointment Type	Status	Active Date
100311
AMTRUST INSURANCE COMPANY	Casualty	Active	04/16/2019
	Property	Active	04/16/2019
113385
Company Name	Appointment Type	Status	Active Date
EMPLOYERS ASSURANCE COMPANY	Casualty	Active	06/28/2021
100892
Company Name	Appointment Type	Status	Active Date
EMPLOYERS COMPENSATION INSURANCE COMPANY	Casualty	Active	06/28/2021
111020
Company Name	Appointment Type	Status	Active Date
EMPLOYERS PREFERRED INSURANCE COMPANY	Casualty	Active	06/28/2021
100334
Company Name	Appointment Type	Status	Active Date
MILFORD CASUALTY INSURANCE COMPANY	Casualty	Active	04/16/2019
	Property	Active	04/16/2019
1776
Company Name	Appointment Type	Status	Active Date
OHIO SECURITY INSURANCE COMPANY	Casualty	Active	11/10/2020
	Property	Active	11/10/2020
109340
Company Name	Appointment Type	Status	Active Date
PARK NATIONAL INSURANCE COMPANY	Casualty	Active	04/16/2019
	Property	Active	04/16/2019
100333
Company Name	Appointment Type	Status	Active Date
SECURITY NATIONAL INSURANCE COMPANY	Casualty	Active	04/16/2019
	Property	Active	04/16/2019
1702
Company Name	Appointment Type	Status	Active Date
SEQUOIA INSURANCE COMPANY	Casualty	Active	03/21/2019
	Property	Active	03/21/2019
17636
Company Name	Appointment Type	Status	Active Date
TECHNOLOGY INSURANCE COMPANY INC	Casualty	Active	04/16/2019
	Property	Active	04/16/2019
1614
Company Name	Appointment Type	Status	Active Date
WESCO INSURANCE COMPANY	Casualty	Active	04/16/2019
	Property	Active	04/16/2019

row(s) 1 - 19 of 19

Name	Association Type	Agent	Begin Date	End Date
MARK JEFFREY KAPATOES	Designated Resp Lic Prdcr	Yes	02/16/2021	-

1 - 1