DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Gorham, Nicholas	DOIID	974280	NAIC NPN	17000026

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	10/25/2017	12/31/2020
Inactive	Non Resident	Agent	Casualty	10/25/2017	12/31/2020
Active	Non Resident	Independent Adjuster	Property & Casualty	12/22/2023		12/31/2024
Inactive	Non Resident	Staff Adjuster	Property & Casualty	8/20/2019	12/15/2023
* 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
Independent Adjuster	10/15/2024	12/31/2024

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	10/31/2017	5/6/2019
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	10/31/2017	5/6/2019
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	10/31/2017	4/23/2020
Inactive	American Modern Home Insurance Company	300791	Agent - Property	10/31/2017	4/23/2020
Inactive	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	9/13/2018	4/23/2020
Inactive	American Modern Property and Casualty Insurance Company	301954	Agent - Property	9/13/2018	4/23/2020
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	11/6/2017	4/23/2020
Inactive	American Southern Home Insurance Company	626276	Agent - Property	11/6/2017	4/23/2020
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	10/31/2017	5/15/2019
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	10/31/2017	5/15/2019
Inactive	Midvale Indemnity Company	300292	Agent - Casualty	11/6/2017	5/16/2019
Inactive	Midvale Indemnity Company	300292	Agent - Property	11/6/2017	5/16/2019
Inactive	RLI Insurance Company	301217	Agent - Casualty	10/31/2017	5/13/2019
Inactive	RLI Insurance Company	301217	Agent - Property	10/31/2017	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	1/4/2024
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	10/31/2017	4/23/2020
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	10/31/2017	4/23/2020