black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

SAM HANTHALEY

PRODUCER NON-RESIDENT

License Number:
PRN240822
Status:
First Licensure:
10/22/2014
Cancel Date:
None

Mailing:
FOREST GROVE, OR 97116
Phone:
+1 (314) 493-8000
Email:
sam.hanthaley@ngic.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 10/22/2014

Agency

Name Issue Date License Number Expiration Date Cancel Date
AFFINITY BROKERAGE LLC
10/22/2014 AGN55398
CWI LLC
01/07/2015 AGN173565 04/23/2024
NATIONAL GENERAL INSURANCE MARKETING INC
10/23/2014 AGN43510

Employer

Name Issue Date License Number Expiration Date Cancel Date
DAIRYLAND INSURANCE COMPANY
06/13/2019 PCF721
FOREMOST INSURANCE COMPANY GRAND RAPIDS, MICHIGAN
03/19/2016 PCF445
INTEGON NATIONAL INSURANCE COMPANY
01/21/2016 PCF310
NATIONAL GENERAL INSURANCE COMPANY
10/23/2014 PCF647
NATIONWIDE ASSURANCE COMPANY
07/14/2015 PCF38952 02/24/2023
NATIONWIDE PROPERTY & CASUALTY INSURANCE COMPANY
07/14/2015 PCF151089 02/24/2023
PROGRESSIVE NORTHERN INSURANCE COMPANY
11/09/2014 PCF51006
PROGRESSIVE NORTHWESTERN INSURANCE COMPANY
11/09/2014 PCF27738

Authority

Description Issue Date Termination Date Status
CASUALTY 10/22/2014 Active
PROPERTY 10/22/2014 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
17400116

Other Addresses

Address Type
1100 NW COMPTON WAY FL 2
BEAVERTON, OR 97006-2291
Office

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 10/21/2025 04:12:29 AM