DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Samples, Marcia	DOIID	662468	NAIC NPN	7899250

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	8/23/2007	12/31/2017
Inactive	Non Resident	Agent	Casualty	8/23/2007	12/31/2017
* 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	Bristol West Insurance Company	301655	Agent - Casualty	5/7/2013	3/16/2017
Inactive	Bristol West Insurance Company	301655	Agent - Property	5/7/2013	3/16/2017
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	5/7/2013	3/16/2017
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	5/7/2013	3/16/2017
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	5/7/2013	7/28/2016
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	5/7/2013	7/28/2016
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	5/7/2013	7/28/2016
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	5/7/2013	7/28/2016
Inactive	Rural Community Insurance Company	301891	Agent - Property	9/19/2014	1/9/2017
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	2/27/2008	12/29/2016
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	2/27/2008	12/29/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Property	3/10/2008	12/13/2016
Inactive	USI Insurance Services National, Inc	509421	Agent - Casualty	3/10/2008	12/13/2016