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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	08/15/2025	10/31/2025
Surplus Lines Broker	08/15/2025	10/31/2025

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