DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Forcum, Christopher Loren	DOIID	716912	NAIC NPN	9156264

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Casualty	4/24/2013	9/1/2019
Inactive	Resident	Agent	Life	4/24/2013	9/1/2019
Inactive	Resident	Agent	Property	4/24/2013	9/1/2019
Inactive	Resident	Agent	Limited Line Credit	4/24/2013	8/31/2019
* 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	Dairyland Insurance Company	301370	Agent - Casualty	4/24/2013	9/1/2019
Inactive	Dairyland Insurance Company	301370	Agent - Property	4/24/2013	9/1/2019
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	4/24/2013	2/23/2016
Inactive	Protective Life Insurance Company	300638	Agent - Limited Line Credit	6/30/2016	8/1/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Harley-Davidson Ins Services Inc	545855	Agent - Casualty	4/24/2013	9/1/2019
Denied	Harley-Davidson Ins Services Inc	545855	Agent - Life
Inactive	Harley-Davidson Ins Services Inc	545855	Agent - Limited Line Credit	4/24/2013	2/23/2016
Inactive	Harley-Davidson Ins Services Inc	545855	Agent - Property	4/24/2013	9/1/2019
Inactive	Sills Cycle Center, Inc.	526992	Agent - Limited Line Credit	4/24/2013	3/31/2018