Individual Information

KELLY CHRISTOPHER FIORENTINO

LAWRENCEVILLE, GA 30043-6979

Active

ywinters@nbis.com

05/24/2010

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	700145	05/24/2010	Active	05/24/2010	05/31/2025
Non-Res. Managing Gen. Agt/Agy	3610785	11/19/2020	Active	11/19/2020	11/30/2023
Non-Res. Surplus Lines Broker	717911	09/22/2010	Active	09/22/2010	09/30/2025

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	05/24/2010	Active	05/24/2010
Managing General Agent	11/19/2020	Active	11/19/2020
Property	05/24/2010	Active	05/24/2010
Surplus Lines	09/22/2010	Active	08/14/2014

Company Name	Appointment Type	Status	Active Date
132
CAROLINA CASUALTY INSURANCE COMPANY	Casualty	Active	02/27/2014
287
Company Name	Appointment Type	Status	Active Date
GRANITE STATE INSURANCE COMPANY	Casualty	Active	06/09/2015
	Property	Active	06/09/2015
1507
Company Name	Appointment Type	Status	Active Date
ILLINOIS NATIONAL INSURANCE COMPANY	Casualty	Active	06/09/2015
	Property	Active	06/09/2015
11243
Company Name	Appointment Type	Status	Active Date
MANUFACTURERS ALLIANCE INSURANCE COMPANY	Casualty	Active	03/07/2018
	Property	Active	03/07/2018
1373
Company Name	Appointment Type	Status	Active Date
MIDWEST EMPLOYERS CASUALTY COMPANY	Casualty	Active	02/27/2014
466
Company Name	Appointment Type	Status	Active Date
NEW HAMPSHIRE INSURANCE COMPANY	Casualty	Active	06/09/2015
	Property	Active	06/09/2015
807
Company Name	Appointment Type	Status	Active Date
PENNSYLVANIA MANUFACTURERS ASSOCIATION INSURANCE	Casualty	Active	03/07/2018
	Property	Active	03/07/2018
11244
Company Name	Appointment Type	Status	Active Date
PENNSYLVANIA MANUFACTURERS INDEMNITY COMPANY	Casualty	Active	03/07/2018
	Property	Active	03/07/2018

row(s) 1 - 14 of 14

Organization	Association Type	Type	Beg dte	End dte
NBIS CONSTRUCTION & TRANSPORT INSURANCE SERVICES INC	Designated Resp Lic Prdcr	Agency	10/09/2020	-

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