DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Jorgensen, Michael Robert	DOIID	1084397	NAIC NPN	19495982

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Casualty	10/1/2020	11/1/2022
Inactive	Resident	Agent	Property	9/29/2020	11/1/2022
Denied	Resident	Temporary Agent	Casualty
Denied	Resident	Temporary Agent	Property
* 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	9/13/2021	11/1/2022
Inactive	American Modern Home Insurance Company	300791	Agent - Property	9/13/2021	11/1/2022
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	10/7/2020	11/1/2022
Inactive	Bristol West Insurance Company	301655	Agent - Property	10/7/2020	11/1/2022
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	10/7/2020	11/1/2022
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	10/7/2020	11/1/2022
Inactive	Milbank Insurance Company	925185	Agent - Casualty	7/6/2021	4/12/2022
Inactive	Milbank Insurance Company	925185	Agent - Property	7/6/2021	4/12/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Oakmonte Insurance, LLC	1050504	Agent - Casualty	10/7/2020	3/21/2022
Inactive	Oakmonte Insurance, LLC	1050504	Agent - Property	10/7/2020	3/21/2022