DEPARTMENT OF INSURANCE

Affiliations

Name	Chamberlain, Jason	DOIID	842265	NAIC NPN	17232494

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Travel	6/4/2014	9/30/2019
Inactive	Non Resident	Agent	Property	10/18/2021	9/30/2025
Inactive	Non Resident	Agent	Casualty	10/18/2021	9/30/2025
* 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
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	6/19/2015	5/4/2018
Inactive	American Modern Home Insurance Company	300791	Agent - Property	6/19/2015	5/4/2018
Inactive	American National Property and Casualty Company	300392	Agent - Casualty	6/25/2016	6/15/2018
Inactive	American National Property and Casualty Company	300392	Agent - Property	6/25/2016	6/15/2018
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	6/19/2015	5/4/2018
Inactive	American Southern Home Insurance Company	626276	Agent - Property	6/19/2015	5/4/2018
Inactive	American Strategic Insurance Corp	883540	Agent - Casualty	4/12/2024	7/2/2024
Inactive	American Strategic Insurance Corp	883540	Agent - Property	4/12/2024	7/2/2024
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	6/12/2024	9/30/2025
Inactive	Bristol West Insurance Company	301655	Agent - Property	6/12/2024	9/30/2025
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	11/30/2021	4/14/2023
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	11/30/2021	4/14/2023
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/2/2024	9/30/2025
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/2/2024	9/30/2025
Inactive	Homesite Insurance Company	301139	Agent - Casualty	4/10/2018	2/26/2019
Inactive	Homesite Insurance Company	301139	Agent - Property	4/10/2018	2/26/2019
Inactive	QBE Insurance Corporation	300515	Agent - Casualty	7/25/2017	10/17/2018
Inactive	QBE Insurance Corporation	300515	Agent - Property	7/25/2017	10/17/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	4/25/2016	5/3/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	4/25/2016	5/3/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/25/2016	5/3/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/25/2016	5/3/2018
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	11/20/2017	9/30/2019
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	11/20/2017	9/30/2019
Inactive	Trusted Resource Underwriters Exchange of Ohio	581481	Agent - Casualty	6/19/2015	5/4/2018
Inactive	Trusted Resource Underwriters Exchange of Ohio	581481	Agent - Property	6/19/2015	5/4/2018
Inactive	United States Fire Insurance Company	582240	Agent - Casualty	5/10/2016	2/25/2019
Inactive	United States Fire Insurance Company	582240	Agent - Property	5/10/2016	2/25/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Banc Insurance Agency,Inc.	691585	Agent - Casualty	7/23/2014	9/30/2019
Inactive	Banc Insurance Agency,Inc.	691585	Agent - Property	7/23/2014	9/30/2019
Inactive	Community Financial Services Insurance, LLC	702941	Agent - Casualty	7/23/2014	9/30/2019
Inactive	Community Financial Services Insurance, LLC	702941	Agent - Property	7/23/2014	9/30/2019
Inactive	Overstock Com Ins Agency	831000	Agent - Casualty	7/23/2014	9/30/2019
Inactive	Overstock Com Ins Agency	831000	Agent - Property	7/23/2014	9/30/2019
Inactive	Qw Insurance Solutions, LLC	1047634	Agent - Casualty	6/4/2024	7/17/2024
Inactive	Qw Insurance Solutions, LLC	1047634	Agent - Property	6/4/2024	7/17/2024