DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Lacy, Shantell Monique	DOIID	1216536	NAIC NPN	20385126

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	7/14/2022		1/31/2027
Active	Non Resident	Agent	Property	2/7/2023		1/31/2027
Active	Non Resident	Agent	Casualty	2/7/2023		1/31/2027
Active	Non Resident	Agent	Health	7/14/2022		1/31/2027
* 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
Agent	11/15/2026	01/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	5/29/2025
Active	Aetna Life Insurance Company	301140	Agent - Health	5/29/2025
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	6/1/2025	6/12/2026
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	6/1/2025	6/12/2026
Active	SilverScript Insurance Company	663526	Agent - Health	5/29/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Chubb Insurance Solutions Agency Inc.	505858	Agent - Life
Denied	Chubb Insurance Solutions Agency Inc.	505858	Agent - Health