DEPARTMENT OF INSURANCE

Name	Dougherty, Tracy M	DOIID	591092	NAIC NPN	7709823

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Administrator	Not Applicable	6/10/2004	5/31/2021
Active	Non Resident	Independent Adjuster	Workers' Compensation	4/1/2024		5/31/2025	New York

*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
Independent Adjuster	03/15/2025	05/31/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	Fullscoperms 110 Thames StPortland, ME 041015046
Residence	Not Public Information

Internet Information

Type	Address
Internet	tdougherty#disabilityrms.com
Business Email	tdougherty@yourbenefitexpert.com

Phone Information

Type	Phone
Business / Home Office	(207) 766-3428