Individual Information

JARED DORNBUSCH

LONG LAKE, MN 55349

Active

jdornbus@amfam.com

02/21/2019

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3417381	02/21/2019	Active	02/21/2019	02/29/2028

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	02/21/2019	Active	02/21/2019
Life	02/21/2019	Active	02/21/2019
Property	02/21/2019	Active	02/21/2019

Company Name	Appointment Type	Status	Active Date
126590
AMERICAN FAMILY INSURANCE COMPANY	Casualty	Active	02/26/2019
	Property	Active	02/26/2019
1742
Company Name	Appointment Type	Status	Active Date
AMERICAN FAMILY LIFE INSURANCE COMPANY	Life	Active	02/26/2019
1743
Company Name	Appointment Type	Status	Active Date
AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I.	Casualty	Active	02/26/2019
	Property	Active	02/26/2019
58
Company Name	Appointment Type	Status	Active Date
AMERICAN MODERN HOME INSURANCE COMPANY	Casualty	Active	09/29/2021
	Property	Active	09/29/2021
1744
Company Name	Appointment Type	Status	Active Date
AMERICAN STANDARD INSURANCE COMPANY OF WISCONSIN	Casualty	Active	02/26/2019
261
Company Name	Appointment Type	Status	Active Date
FOREMOST INSURANCE COMPANY GRAND RAPIDS MICHIGAN	Casualty	Active	02/12/2024
	Property	Active	02/12/2024
1409
Company Name	Appointment Type	Status	Active Date
MIDVALE INDEMNITY COMPANY	Casualty	Active	02/26/2025
	Property	Active	02/26/2025

row(s) 1 - 12 of 12

Organization	Association Type	Type	Beg dte	End dte
DORNBUSCH & ASSOCIATES LLC	Designated Resp Lic Prdcr	Agency	09/03/2020	-

1 - 1