DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Martin, Jeffrey W	DOIID	362432	NAIC NPN	114836

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	2/23/2023		1/31/2026
Active	Non Resident	Agent	Casualty	2/23/2023		1/31/2026
Inactive	Non Resident	Agent	General Lines	7/28/1992	8/15/2000
Inactive	Non Resident	Surplus Lines Broker	Not Applicable	8/11/2009	9/17/2010
* 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 Family Home Insurance Company	301817	Agent - Casualty	8/15/2000	10/23/2012
Inactive	American Family Home Insurance Company	301817	Agent - General Lines	12/30/1998	8/15/2000
Inactive	American Family Home Insurance Company	301817	Agent - Property	8/15/2000	10/23/2012
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	8/15/2000	10/23/2012
Inactive	American Modern Home Insurance Company	300791	Agent - General Lines	7/28/1992	8/15/2000
Inactive	American Modern Home Insurance Company	300791	Agent - Property	8/15/2000	10/23/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Atlas Ins Agcy Inc	523813	Agent - Property	1/29/2007	6/30/2011
Inactive	Atlas Ins Agcy Inc	523813	Agent - Casualty	1/29/2007	6/30/2011
Inactive	Atlas Ins Agcy Inc	523813	Surplus Lines Broker - Not Applicable	8/19/2009	9/17/2010