DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Long, Jeremy	DOIID	1110106	NAIC NPN	18336865

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	11/20/2023		2/28/2025
Active	Non Resident	Agent	Life	11/20/2023		2/28/2025
* 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	12/15/2024	02/28/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	4/19/2022	2/28/2023
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	4/19/2022	2/28/2023
Active	Markel Insurance Company	301475	Agent - Health	1/16/2024
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	1/4/2023	2/28/2023
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	1/4/2023	2/28/2023
Inactive	Starmount Life Insurance Company	628031	Agent - Health	1/4/2023	2/28/2023
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	1/4/2023	2/28/2023
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	1/4/2023	2/28/2023
Inactive	Unum Insurance Company	301499	Agent - Health	1/4/2023	2/28/2023
Inactive	Unum Insurance Company	301499	Agent - Life	1/4/2023	2/28/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Gallagher Benefit Services Inc	525782	Agent - Life
Active	Gallagher Benefit Services Inc	525782	Agent - Health	1/16/2024