DEPARTMENT OF INSURANCE

Name	Samples, Brad W	DOIID	594622	NAIC NPN	3314006

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	8/27/2004	7/31/2024
Active	Non Resident	Agent	Property	8/27/2004	7/31/2024
Active	Non Resident	Agent	Life	8/27/2004	7/31/2024

*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

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	Encore Insurance Group LLC P O Box 162 510 S. Buckeye StOsgood, IN 47037
Residence	Not Public Information

Internet Information

Type	Address
Business Email	bsamples@encoreinsgroup.com

Phone Information

Type	Phone
Business / Home Office	(812) 689-5630
Business / Home Office	(812) 689-5630