DEPARTMENT OF INSURANCE

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		1/31/2025
Active	Non Resident	Agent	Property	2/7/2023		1/31/2025
Active	Non Resident	Agent	Casualty	2/7/2023		1/31/2025
Active	Non Resident	Agent	Health	7/14/2022		1/31/2025
* 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	11/15/2024	01/31/2025

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