DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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.

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