DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Mack, Benjamin Jason	DOIID	800959	NAIC NPN	7957009

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	6/3/2021		5/31/2026
Active	Non Resident	Agent	Casualty	6/3/2021		5/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	6/3/2021		5/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	03/15/2024	05/31/2024	03/07/2024	03/07/2024	Yes
Surplus Lines Broker	03/15/2024	05/31/2024	03/07/2024	03/07/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Midvale Indemnity Company	300292	Agent - Casualty	4/20/2022
Active	Midvale Indemnity Company	300292	Agent - Property	4/20/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bowhead Specialty Underwriters Inc.	1102220	Agent - Property	4/20/2022
Active	Bowhead Specialty Underwriters Inc.	1102220	Agent - Property	4/17/2024
Active	Bowhead Specialty Underwriters Inc.	1102220	Agent - Casualty	4/20/2022
Active	Bowhead Specialty Underwriters Inc.	1102220	Agent - Casualty	4/17/2024
Active	Bowhead Specialty Underwriters Inc.	1102220	Surplus Lines Broker - Not Applicable	4/12/2022