DEPARTMENT OF INSURANCE

Name	Staten, Randolph Wilbert	DOIID	882863	NAIC NPN	17533545

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Personal Lines	7/10/2015	7/31/2016
Active	Non Resident	Independent Adjuster	Property & Casualty	7/19/2023		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
Independent Adjuster	05/15/2024	07/31/2024	06/25/2024	06/25/2024	Yes

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	3717 Millstream Ridge Dr Charlotte, NC 282697918
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(800) 841-3000