DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Jorgensen, Michael Henry	DOIID	1307925	NAIC NPN	2635940

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	10/30/2023		2/28/2025
Active	Non Resident	Agent	Casualty	10/30/2023		2/28/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/28/2024		2/28/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Assuredpartners Of Oregon LLC	905764	Surplus Lines Broker - Not Applicable	6/10/2024