Individual Information

DAREN KARL D IPPOLITO

Address:

MARS, PA 16046-1210

Status:

Active

Email:

daren@providentins.com

Date:

04/06/2012

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	812310	04/06/2012	Active	04/06/2012	04/30/2024

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	03/20/2015	Active	03/20/2015
Health	04/06/2012	Active	04/06/2012
Life	04/06/2012	Active	04/06/2012
Property	03/20/2015	Active	03/20/2015

Company Name	Appointment Type	Status	Active Date
1163
AXIS INSURANCE COMPANY	Health	Active	03/08/2013
309
Company Name	Appointment Type	Status	Active Date
HARTFORD FIRE INSURANCE COMPANY	Health	Active	05/14/2018

row(s) 1 - 2 of 2

Organization	Association Type	Type	Beg dte	End dte
PROVIDENT AGENCY INC	Designated Resp Lic Prdcr	Agency	09/15/2020	-

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