Individual Information

MICHAEL HENRY JORGENSEN

Address:

EUGENE, OR 97408-7440

Status:

Active

Email:

mike.jorgensen@assuredpartners.com

Date:

07/09/2015

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	1104282	07/09/2015	Active	07/09/2015	07/31/2027
Non-Res. Surplus Lines Broker	4012063	05/29/2024	Active	05/29/2024	05/31/2027

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	07/09/2015	Active	07/09/2015
Property	07/09/2015	Active	07/09/2015
Surplus Lines	05/29/2024	Active	05/29/2024

Company Name	Appointment Type	Status	Active Date
965
ACUITY A MUTUAL INSURANCE COMPANY	Casualty	Active	08/29/2024
	Property	Active	08/29/2024
1741
Company Name	Appointment Type	Status	Active Date
HUDSON INSURANCE COMPANY	Casualty	Active	03/03/2021
	Property	Active	03/03/2021

row(s) 1 - 4 of 4

Organization	Association Type	Type	Beg dte	End dte
ASSUREDPARTNERS OF OREGON LLC	Designated Resp Lic Prdcr	Agency	07/03/2024	-

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