DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Chamberlain, Forrest	DOIID	1341111	NAIC NPN	16531787

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	5/20/2024		7/31/2027
Active	Non Resident	Agent	Casualty	5/20/2024		7/31/2027
* 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	05/15/2025	07/31/2025	07/01/2025	07/01/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	AGCS Marine Insurance Company	300403	Agent - Casualty	5/24/2024
Active	AGCS Marine Insurance Company	300403	Agent - Property	5/24/2024
Active	Greenwich Insurance Company	301754	Agent - Casualty	11/21/2024
Active	Greenwich Insurance Company	301754	Agent - Property	11/21/2024
Inactive	XL Reinsurance America Inc.	300723	Agent - Casualty	10/16/2024	11/21/2024
Inactive	XL Reinsurance America Inc.	300723	Agent - Property	10/16/2024	11/21/2024
Active	XL Specialty Insurance Company	301605	Agent - Casualty	10/16/2024
Active	XL Specialty Insurance Company	301605	Agent - Property	10/16/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Casualty	5/24/2024
Active	Arthur J. Gallagher Risk Management Services, LLC	539806	Agent - Property	5/24/2024