DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Jorgensen, Michael Henry	DOIID	1307925	NAIC NPN	2635940

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	10/30/2023		2/28/2027
Active	Non Resident	Agent	Property	10/30/2023		2/28/2027
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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	12/15/2026	02/28/2027
Surplus Lines Broker	12/15/2026	02/28/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Chiron Insurance Company	1036458	Agent - Casualty	5/22/2025
Active	Chiron Insurance Company	1036458	Agent - Property	5/22/2025
Active	Pharmacists Insurance Company	301292	Agent - Casualty	5/22/2025
Active	Pharmacists Insurance Company	301292	Agent - Property	5/22/2025
Active	United Financial Casualty Company	301886	Agent - Casualty	3/21/2025
Active	United Financial Casualty Company	301886	Agent - Property	3/21/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Assuredpartners Of Oregon LLC	905764	Agent - Casualty	12/10/2025
Active	Assuredpartners Of Oregon LLC	905764	Agent - Property	12/10/2025
Active	Assuredpartners Of Oregon LLC	905764	Surplus Lines Broker - Not Applicable	6/10/2024