DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mitchell, Jacob	DOIID	939971	NAIC NPN	18238393

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Travel	3/19/2020		6/30/2026
Active	Resident	Agent	Life	4/27/2022		6/30/2026
Active	Resident	Agent	Property	2/13/2017		6/30/2026
Active	Resident	Agent	Casualty	11/28/2017		6/30/2026
Active	Resident	Agent	Health	10/13/2021		6/30/2026
Denied	Resident	Independent Adjuster	Property & Casualty
Active	Resident	Surplus Lines Broker	Not Applicable	3/28/2019		6/30/2026
* 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	04/15/2026	06/30/2026
Surplus Lines Broker	04/15/2026	06/30/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	BCS Insurance Company	300294	Agent - Casualty	2/11/2020
Active	BCS Insurance Company	300294	Agent - Health	2/7/2022
Active	BCS Insurance Company	300294	Agent - Property	2/11/2020
Active	BCS Insurance Company	300294	Agent - Travel	2/7/2022
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/25/2022	5/18/2023
Active	Jefferson Insurance Company	301127	Agent - Casualty	2/11/2020
Active	Jefferson Insurance Company	301127	Agent - Property	2/11/2020
Active	Jefferson Insurance Company	301127	Agent - Travel	2/7/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	7/25/2022	5/18/2023
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	7/25/2022	12/22/2022
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	7/25/2022	5/18/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Concentrix Cvg Cmg Insurance Services Llc	811724	Agent - Casualty	6/10/2022
Active	Concentrix Cvg Cmg Insurance Services Llc	811724	Agent - Property	6/10/2022
Active	Concentrix Cvg Cmg Insurance Services Llc	811724	Agent - Health	8/30/2022
Active	Concentrix Cvg Cmg Insurance Services Llc	811724	Agent - Life	8/30/2022
Inactive	Intl Insurtech Services, LLC	1035304	Agent - Casualty	2/17/2020	3/31/2021
Inactive	Intl Insurtech Services, LLC	1035304	Agent - Property	2/17/2020	3/31/2021
Denied	Intl Insurtech Services, LLC	1035304	Agent - Travel
Active	Societe Air France	1081383	Agent - Casualty	4/17/2020
Active	Societe Air France	1081383	Agent - Property	4/17/2020
Active	Societe Air France	1081383	Agent - Health	2/24/2022