DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Sampson, Tavie Renee	DOIID	1014491	NAIC NPN	13603506

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Independent Adjuster	Property & Casualty	2/20/2023		8/31/2027
Inactive	Non Resident	Staff Adjuster	Property & Casualty	10/10/2018	2/20/2023
* 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	06/15/2025	08/31/2025	06/13/2025	06/13/2025	Yes

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	PTZ Insurance Agency LTD	695420	Independent Adjuster - Property & Casualty	6/28/2023