DEPARTMENT OF INSURANCE

Name	Back, Brandon	DOIID	707137	NAIC NPN	13471584

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	5/22/2018	6/30/2024
Active	Non Resident	Agent	Casualty	5/22/2018	6/30/2024
Active	Non Resident	Agent	Life	11/17/2018	6/30/2024

*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	04/15/2024	06/30/2024

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
Business / Home Office	American Modern Home Insurance Company 7000 Midland BlvdAmelia, OH 451022608
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(859) 905-6290