DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Chamberlain, Lisa Pratt	DOIID	880309	NAIC NPN	5942242

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	6/12/2015		10/31/2026
Active	Non Resident	Agent	Casualty	6/12/2015		10/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	6/12/2015		10/31/2026
* 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	08/15/2024	10/31/2024	08/23/2024	08/23/2024	Yes
Surplus Lines Broker	08/15/2024	10/31/2024	08/23/2024	08/23/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	11/20/2020
Active	SAFECO Insurance Company of America	300159	Agent - Property	11/20/2020

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	4/7/2021
Active	Tis Ins Services Inc	523150	Agent - Casualty	4/7/2021
Active	Tis Ins Services Inc	523150	Surplus Lines Broker - Not Applicable	4/7/2021