DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Donnelly, Stacey Marie	DOIID	1005606	NAIC NPN	16139967

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Independent Adjuster	Workers' Compensation	5/10/2022		10/31/2026
Inactive	Non Resident	Staff Adjuster	Workers' Compensation	8/17/2018	5/10/2022
* 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
Independent Adjuster	08/15/2024	10/31/2024	09/05/2024	09/05/2024	Yes

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AIG Property Casualty Company	300621	Independent Adjuster - Workers' Compensation	5/18/2022	8/19/2022
Inactive	Aig Claims Inc	401148	Staff Adjuster - Workers' Compensation	9/12/2018	5/10/2022