DEPARTMENT OF INSURANCE

Name	Jorgensen, Michael Henry	DOIID	1307925	NAIC NPN	2635940

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	10/30/2023	2/28/2025
Active	Non Resident	Agent	Casualty	10/30/2023	2/28/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/28/2024	2/28/2027

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Residence	Not Public Information
Business / Home Office	3125 Chad Dr Ste 120 Eugene, OR 974087440

Phone Information

Type	Phone
Business / Home Office	(863) 333-7738