Individual Information

MICHAEL HENRY JORGENSEN

EUGENE, OR 97408-7440

Active

mike.jorgensen@assuredpartners.com

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
157726
Company Name	Appointment Type	Status	Active Date
CHIRON INSURANCE COMPANY	Casualty	Active	05/22/2025
	Property	Active	05/22/2025
1201
Company Name	Appointment Type	Status	Active Date
FIDELITY AND GUARANTY INSURANCE COMPANY	Casualty	Active	03/18/2025
	Property	Active	03/18/2025
1741
Company Name	Appointment Type	Status	Active Date
HUDSON INSURANCE COMPANY	Casualty	Active	03/03/2021
	Property	Active	03/03/2021
11662
Company Name	Appointment Type	Status	Active Date
PHARMACISTS MUTUAL INSURANCE COMPANY	Casualty	Active	05/22/2025
	Property	Active	05/22/2025
114730
Company Name	Appointment Type	Status	Active Date
PRIVILEGE UNDERWRITERS RECIPROCAL EXCHANGE	Casualty	Active	10/20/2025
	Property	Active	10/20/2025
1488
Company Name	Appointment Type	Status	Active Date
TRAVELERS PROPERTY CASUALTY INSURANCE COMPANY	Casualty	Active	11/17/2025
	Property	Active	11/17/2025
1261
Company Name	Appointment Type	Status	Active Date
UNITED FINANCIAL CASUALTY COMPANY	Casualty	Active	03/21/2025
	Property	Active	03/21/2025

row(s) 1 - 16 of 16

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

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