DEPARTMENT OF INSURANCE

Affiliations

Name	Jorgenson, Nicholas	DOIID	855088	NAIC NPN	16100921

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Casualty	10/3/2014	6/30/2019
Inactive	Non Resident	Agent	Property	10/3/2014	6/30/2019
* 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	American Fire and Casualty Company	300567	Agent - Casualty	1/27/2015	6/30/2019
Inactive	American Fire and Casualty Company	300567	Agent - Property	1/27/2015	6/30/2019
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Consolidated Insurance Company	300943	Agent - Property	1/27/2015	6/30/2019
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/5/2018	8/29/2018
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/5/2018	8/29/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	6/5/2018	8/29/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	6/5/2018	8/29/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	6/5/2018	8/29/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	6/5/2018	8/29/2018
Inactive	Indiana Insurance Company	301909	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Indiana Insurance Company	301909	Agent - Property	1/27/2015	6/30/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	1/27/2015	6/30/2019
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	1/27/2015	6/30/2019
Inactive	Ohio Security Insurance Company	300622	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Ohio Security Insurance Company	300622	Agent - Property	1/27/2015	6/30/2019
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Property	1/27/2015	6/30/2019
Inactive	Peerless Insurance Company	301910	Agent - Casualty	1/27/2015	6/30/2019
Inactive	Peerless Insurance Company	301910	Agent - Property	1/27/2015	6/30/2019
Inactive	Rural Community Insurance Company	301891	Agent - Casualty	10/31/2014	3/8/2016
Inactive	Rural Community Insurance Company	301891	Agent - Property	10/31/2014	3/8/2016
Inactive	West American Insurance Company	301112	Agent - Casualty	1/27/2015	6/30/2019
Inactive	West American Insurance Company	301112	Agent - Property	1/27/2015	6/30/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Property	11/3/2014	6/30/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Casualty	11/3/2014	6/30/2019
Inactive	Usi Insurance Services LLC	669260	Agent - Property	1/8/2019	6/30/2019
Inactive	Usi Insurance Services LLC	669260	Agent - Casualty	1/8/2019	6/30/2019