DEPARTMENT OF INSURANCE

Affiliations

Name	Chamberlain, Jason	DOIID	842265	NAIC NPN	17232494

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	10/18/2021		9/30/2025
Active	Non Resident	Agent	Property	10/18/2021		9/30/2025
Inactive	Non Resident	Agent	Travel	6/4/2014	9/30/2019
* 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	07/15/2025	09/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	6/19/2015	5/4/2018
Inactive	American Modern Home Insurance Company	300791	Agent - Property	6/19/2015	5/4/2018
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	6/19/2015	5/4/2018
Inactive	American Modern Select Insurance Company	581481	Agent - Property	6/19/2015	5/4/2018
Inactive	American National Property and Casualty Company	300392	Agent - Casualty	6/25/2016	6/15/2018
Inactive	American National Property and Casualty Company	300392	Agent - Property	6/25/2016	6/15/2018
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	6/19/2015	5/4/2018
Inactive	American Southern Home Insurance Company	626276	Agent - Property	6/19/2015	5/4/2018
Inactive	American Strategic Insurance Corp	883540	Agent - Casualty	4/12/2024	7/2/2024
Inactive	American Strategic Insurance Corp	883540	Agent - Property	4/12/2024	7/2/2024
Active	Bristol West Insurance Company	301655	Agent - Casualty	6/12/2024
Active	Bristol West Insurance Company	301655	Agent - Property	6/12/2024
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	11/30/2021	4/14/2023
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	11/30/2021	4/14/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/2/2024
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/2/2024
Inactive	Homesite Insurance Company	301139	Agent - Casualty	4/10/2018	2/26/2019
Inactive	Homesite Insurance Company	301139	Agent - Property	4/10/2018	2/26/2019
Inactive	QBE Insurance Corporation	300515	Agent - Casualty	7/25/2017	10/17/2018
Inactive	QBE Insurance Corporation	300515	Agent - Property	7/25/2017	10/17/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	4/25/2016	5/3/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	4/25/2016	5/3/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/25/2016	5/3/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/25/2016	5/3/2018
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	11/20/2017	9/30/2019
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	11/20/2017	9/30/2019
Inactive	United States Fire Insurance Company	582240	Agent - Casualty	5/10/2016	2/25/2019
Inactive	United States Fire Insurance Company	582240	Agent - Property	5/10/2016	2/25/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Banc Ins Agency Inc	691585	Agent - Casualty	7/23/2014	9/30/2019
Inactive	Banc Ins Agency Inc	691585	Agent - Property	7/23/2014	9/30/2019
Inactive	Community Financial Services Insurance, LLC	702941	Agent - Casualty	7/23/2014	9/30/2019
Inactive	Community Financial Services Insurance, LLC	702941	Agent - Property	7/23/2014	9/30/2019
Inactive	Overstock Com Ins Agency	831000	Agent - Casualty	7/23/2014	9/30/2019
Inactive	Overstock Com Ins Agency	831000	Agent - Property	7/23/2014	9/30/2019
Inactive	Qw Insurance Solutions, LLC	1047634	Agent - Casualty	6/4/2024	7/17/2024
Inactive	Qw Insurance Solutions, LLC	1047634	Agent - Property	6/4/2024	7/17/2024