DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Long, Jack Nicholas	DOIID	1309542	NAIC NPN	18702162

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	11/8/2023		4/30/2025
Active	Non Resident	Agent	Casualty	11/8/2023		4/30/2025
* 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	02/15/2025	04/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bristol West Insurance Company	301655	Agent - Casualty	12/14/2023
Active	Bristol West Insurance Company	301655	Agent - Property	12/14/2023
Active	CSAA Fire & Casualty Insurance Company	606666	Agent - Casualty	11/16/2023
Active	CSAA Fire & Casualty Insurance Company	606666	Agent - Property	11/16/2023
Active	CSAA General Insurance Company	606675	Agent - Casualty	11/16/2023
Active	CSAA General Insurance Company	606675	Agent - Property	11/16/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	12/14/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	12/14/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aca Club Insurance Agency, Inc.	1033550	Agent - Casualty	11/16/2023
Active	Aca Club Insurance Agency, Inc.	1033550	Agent - Property	11/16/2023