DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Douglas, Stacy Renea	DOIID	690520	NAIC NPN	7152324

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	10/24/2018		10/31/2025
Active	Non Resident	Agent	Casualty	10/24/2018		10/31/2025
Active	Non Resident	Surplus Lines Broker	Not Applicable	1/12/2023		10/31/2025
* 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
Active	Amerisure Insurance Company	300298	Agent - Casualty	9/22/2022
Active	Amerisure Insurance Company	300298	Agent - Property	9/22/2022
Active	Amerisure Mutual Insurance Company	301576	Agent - Casualty	9/22/2022
Active	Amerisure Mutual Insurance Company	301576	Agent - Property	9/22/2022
Active	Amerisure Partners Insurance Company	760791	Agent - Casualty	9/22/2022
Active	Amerisure Partners Insurance Company	760791	Agent - Property	9/22/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Tis Ins Services Inc	523150	Agent - Property	5/8/2023
Active	Tis Ins Services Inc	523150	Agent - Casualty	5/8/2023
Active	Tis Ins Services Inc	523150	Surplus Lines Broker - Not Applicable	5/8/2023