DEPARTMENT OF INSURANCE

Affiliations

Name	Dougherty, Tracy M	DOIID	591092	NAIC NPN	7709823

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	6/10/2004	5/31/2021
Active	Non Resident	Independent Adjuster	Workers' Compensation	4/1/2024		5/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Disability Reinsurance Management Services Inc.	394470	Administrator - Not Applicable	6/10/2004	5/31/2021