DEPARTMENT OF INSURANCE

Name	Roush, Derek	DOIID	1222412	NAIC NPN	20366991

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	8/10/2022	10/31/2023

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

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	963 Napolean Way Traverse City, MI 496968390
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(231) 645-1695