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  5. JACOBS INSURANCE INC.

JACOBS INSURANCE INC.

Company Details

Entity Name: JACOBS INSURANCE INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 10 Oct 2007 (17 years ago)
Document Number: P07000111517
FEI/EIN Number 352311434
Address: 3525 MONTANTE BLVD, LAKE WORTH, FL, 33461, US
Mail Address: 3525 MONTANTE BLVD, PALM SPRINGS, FL, 33461, US
ZIP code: 33461
County: Palm Beach
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACOBS INSURANCE, INC. 401(K) PLAN 2013 352311434 2014-02-05 JACOBS INSURANCE, INC 7
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Signature of
Role Plan administrator
Date 2014-02-05
Name of individual signing JOHN JACOBS
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE, INC. 401(K) PLAN 2013 352311434 2014-02-06 JACOBS INSURANCE, INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Signature of
Role Plan administrator
Date 2014-02-06
Name of individual signing JOHN JACOBS
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE, INC. 401(K) PLAN 2013 352311434 2014-02-05 JACOBS INSURANCE, INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Signature of
Role Plan administrator
Date 2014-02-05
Name of individual signing FRANK HARRISON
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE, INC. 401(K) PLAN 2013 352311434 2014-01-30 JACOBS INSURANCE, INC 7
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Signature of
Role Plan administrator
Date 2014-01-30
Name of individual signing FRANK HARRISON
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE, INC. 401(K) PLAN 2013 352311434 2014-01-30 JACOBS INSURANCE, INC 7
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Signature of
Role Plan administrator
Date 2014-01-30
Name of individual signing JOHN JACOBS
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE, INC. 401(K) PLAN 2012 352311434 2013-03-27 JACOBS INSURANCE, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Signature of
Role Plan administrator
Date 2013-03-27
Name of individual signing JOHN JACOBS
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE, INC. 401(K) PLAN 2011 352311434 2012-06-13 JACOBS INSURANCE, INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 812990
Sponsor’s telephone number 5619678400
Plan sponsor’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406

Plan administrator’s name and address
Administrator’s EIN 352311434
Plan administrator’s name JACOBS INSURANCE, INC
Plan administrator’s address 2135 S. CONGRESS AVENUE, SUITE B, WEST PALM BEACH, FL, 33406
Administrator’s telephone number 5619678400

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing JOHN JACOBS
Valid signature Filed with authorized/valid electronic signature
JACOBS INSURANCE INC 401 K PROFIT SHARING PLAN TRUST 2010 352311434 2011-05-23 JACOBS INSURANCE INC 9
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 524210
Sponsor’s telephone number 5619678400
Plan sponsor’s address DBA JOHN JACOBS INSURANCE AGCY, 2135 S CONGRESS AVE, WEST PALM BEACH, FL, 334060000

Plan administrator’s name and address
Administrator’s EIN 352311434
Plan administrator’s name JACOBS INSURANCE INC
Plan administrator’s address DBA JOHN JACOBS INSURANCE AGCY, 2135 S CONGRESS AVE, WEST PALM BEACH, FL, 334060000
Administrator’s telephone number 5619678400

Signature of
Role Plan administrator
Date 2011-05-23
Name of individual signing JACOBS INSURANCE INC
Valid signature Filed with incorrect/unrecognized electronic signature
JACOBS INSURANCE INC 401 K PROFIT SHARING PLAN TRUST 2010 352311434 2011-06-06 JACOBS INSURANCE INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 524210
Sponsor’s telephone number 5619678400
Plan sponsor’s address DBA JOHN JACOBS INSURANCE AGCY, 2135 S CONGRESS AVE, WEST PALM BEACH, FL, 334060000

Plan administrator’s name and address
Administrator’s EIN 352311434
Plan administrator’s name JACOBS INSURANCE INC
Plan administrator’s address DBA JOHN JACOBS INSURANCE AGCY, 2135 S CONGRESS AVE, WEST PALM BEACH, FL, 334060000
Administrator’s telephone number 5619678400

Signature of
Role Plan administrator
Date 2011-06-06
Name of individual signing JACOBS INSURANCE INC
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-06
Name of individual signing JACOBS INSURANCE INC
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CHRZANOWSKI JENNIFER Agent 3525 MONTANTE BLVD, LAKE WORTH, FL, 33461

Manager

Name Role Address
CHRZANOWSKI JENNIFER Manager 3525 MONTANTE BLVD, LAKE WORTH, FL, 33461

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-01-29 3525 MONTANTE BLVD, LAKE WORTH, FL 33461 No data
REGISTERED AGENT ADDRESS CHANGED 2024-01-29 3525 MONTANTE BLVD, LAKE WORTH, FL 33461 No data
REGISTERED AGENT NAME CHANGED 2022-03-10 CHRZANOWSKI, JENNIFER No data
CHANGE OF MAILING ADDRESS 2021-05-05 3525 MONTANTE BLVD, LAKE WORTH, FL 33461 No data

Documents

Name Date
ANNUAL REPORT 2024-01-29
ANNUAL REPORT 2023-02-16
ANNUAL REPORT 2022-03-10
ANNUAL REPORT 2021-01-30
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-02-27
ANNUAL REPORT 2017-03-10
ANNUAL REPORT 2016-01-26
ANNUAL REPORT 2015-02-10

Related by officers

CHRZANOWSKI JENNIFER

KELLY DRIVE, LLC DOUBLE TIME LLC MONVIL, LLC DROSAKIS, LLC GANEY LANE, LLC KELLY DRIVE, LLC

Related by address

3525 MONTANTE BLVD, LAKE WORTH, FL, 33461, US

MONVIL, LLC DROSAKIS, LLC KELLY DRIVE, LLC

3525 MONTANTE BLVD, PALM SPRINGS, FL, 33461, US

KELLY DRIVE, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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