DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Blaize, Merliss	DOIID	1074351	NAIC NPN	19392948

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Personal Lines	2/13/2020	7/6/2023
Inactive	Non Resident	Agent	Health	2/13/2020	7/6/2023
Inactive	Non Resident	Agent	Life	2/13/2020	7/6/2023
Active	Non Resident	Staff Adjuster	Property & Casualty	9/23/2022		7/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AMEX Assurance Company	301728	Agent - Health	5/5/2020	7/6/2023
Inactive	AMEX Assurance Company	301728	Agent - Personal Lines	5/5/2020	7/6/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Assurant Insurance Agency, Inc	559398	Agent - Life
Inactive	Assurant Insurance Agency, Inc	559398	Agent - Health	5/5/2020	6/21/2023