DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Green, Matthew Jacob	DOIID	659576	NAIC NPN	9357035

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	7/13/2007	11/30/2020
Inactive	Non Resident	Agent	Health	2/13/2009	11/30/2020
Inactive	Non Resident	Agent	Casualty	7/13/2007	11/30/2020
Active	Non Resident	Independent Adjuster	Property & Casualty	1/8/2024		11/30/2026
Inactive	Non Resident	Staff Adjuster	Property & Casualty	8/20/2019	12/19/2023
* 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 Connect Property and Casualty Insurance Company	622403	Agent - Casualty	8/6/2007	5/6/2019
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Health	3/2/2009	9/24/2015
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	8/6/2007	5/6/2019
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	7/13/2015	12/13/2019
Inactive	American Modern Home Insurance Company	300791	Agent - Property	7/13/2015	12/13/2019
Inactive	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	3/5/2019	12/13/2019
Inactive	American Modern Property and Casualty Insurance Company	301954	Agent - Property	3/5/2019	12/13/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	7/13/2015	4/23/2020
Inactive	American Modern Select Insurance Company	581481	Agent - Property	7/13/2015	4/23/2020
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	7/13/2015	4/23/2020
Inactive	American Southern Home Insurance Company	626276	Agent - Property	7/13/2015	4/23/2020
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	9/13/2012	5/15/2019
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	9/13/2012	5/15/2019
Inactive	Homesite Insurance Company	301139	Agent - Casualty	10/24/2017	5/16/2019
Inactive	Homesite Insurance Company	301139	Agent - Property	10/24/2017	5/16/2019
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/24/2017	5/16/2019
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/24/2017	5/16/2019
Inactive	RLI Insurance Company	301217	Agent - Casualty	11/28/2011	5/13/2019
Inactive	RLI Insurance Company	301217	Agent - Property	11/28/2011	5/13/2019

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	1/12/2024
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	11/17/2011	4/23/2020
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	11/17/2011	4/23/2020