DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Sampsel, Jacob	DOIID	1176010	NAIC NPN	20164707

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Independent Adjuster	Property & Casualty	7/24/2023		4/30/2027
Inactive	Non Resident	Staff Adjuster	Property & Casualty	12/8/2021	7/17/2023
* 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
Independent Adjuster	02/15/2025	04/30/2025	02/05/2025	02/05/2025	Yes

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	AFICS, Inc	1122840	Independent Adjuster - Property & Casualty	8/7/2023