DEPARTMENT OF INSURANCE

Name	Provenance Specialty Ins Agency LLC	DOIID	714228	NAIC NPN	14980038

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Casualty	9/23/2009	3/31/2025
Active	Resident	Agent	Property	9/23/2009	3/31/2025
Denied	Resident	Agent	Life
Denied	Resident	Agent	Personal Lines
Active	Resident	Surplus Lines Broker	Not Applicable	9/18/2014	3/31/2025

*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	01/15/2025	03/31/2025
Surplus Lines Broker	01/15/2025	03/31/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Business / Home Office	1510 Newtown Pike Suite 146Lexington, KY 40511

Phone Information

Type	Phone
Business / Home Office	(859) 254-3078