DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Campbell Sr, Jack Alan	DOIID	739905	NAIC NPN	15985363

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Casualty	4/21/2015	7/31/2021
Inactive	Resident	Agent	Life	11/1/2010	8/1/2013
Inactive	Resident	Agent	Property	4/21/2015	7/31/2021
* 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 Bankers Insurance Company of Florida	300360	Agent - Casualty	4/27/2015	2/13/2020
Inactive	American Bankers Insurance Company of Florida	300360	Agent - Property	4/27/2015	2/13/2020
Inactive	Forethought Life Insurance Company	301407	Agent - Life	11/1/2010	8/1/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CMH Homes, Inc.	398100	Agent - Property	4/27/2015	2/13/2020
Inactive	CMH Homes, Inc.	398100	Agent - Casualty	4/27/2015	2/13/2020