DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Gonsalves, Shannon Denise	DOIID	591434	NAIC NPN	7895130

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	12/16/2004	8/31/2013
Inactive	Non Resident	Agent	Casualty	12/16/2004	8/31/2013
* 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	Dairyland Insurance Company	301370	Agent - Casualty	10/28/2010	9/8/2012
Inactive	Dairyland Insurance Company	301370	Agent - Property	10/28/2010	9/8/2012
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	2/10/2005	8/31/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	2/10/2005	8/31/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Harley-Davidson Ins Services Inc	545855	Agent - Casualty	2/10/2005	8/31/2012
Inactive	Harley-Davidson Ins Services Inc	545855	Agent - Property	2/10/2005	8/31/2012