DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Staley, Crystal Marie	DOIID	772823	NAIC NPN	6904006

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	1/19/2012		7/31/2026
Active	Non Resident	Agent	Casualty	1/19/2012		7/31/2026
Active	Non Resident	Agent	Personal Lines	1/19/2012		7/31/2026
* 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	05/15/2024	07/31/2024	06/13/2024	06/13/2024	Yes

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	7/3/2012	12/4/2017
Inactive	Bristol West Insurance Company	301655	Agent - Property	7/3/2012	12/4/2017
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/28/2012
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/28/2012
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	9/24/2013	8/29/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	9/24/2013	8/29/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	9/24/2013	8/29/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	9/24/2013	8/29/2018
Active	NCMIC Insurance Company	301007	Agent - Casualty	2/20/2012
Active	NCMIC Insurance Company	301007	Agent - Property	2/20/2012
Active	Professional Solutions Insurance Company	569414	Agent - Casualty	2/20/2012
Active	Professional Solutions Insurance Company	569414	Agent - Property	2/20/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	NCMIC Insurance Services, Inc.	399052	Agent - Property	3/20/2013
Active	NCMIC Insurance Services, Inc.	399052	Agent - Casualty	3/20/2013
Active	Professional Solutions Insurance Services, Inc	631015	Agent - Property	3/20/2013
Active	Professional Solutions Insurance Services, Inc	631015	Agent - Casualty	3/20/2013