black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

TRAVIS BRENDAN HAYNES

PRODUCER NON-RESIDENT

License Number:
PRN100022
Status:
First Licensure:
12/01/2003
Cancel Date:
None

Mailing:
SHERWOOD, OR 97140
Phone:
+1 (603) 620-1055
Email:
thaynes@gotodsi.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 12/01/2003

Agency

Name Issue Date License Number Expiration Date Cancel Date
ACRISURE LLC
02/27/2020 AGN160630
DISABILITY SPECIALIST INC
03/03/2005 AGN111225 11/16/2021

Employer

Name Issue Date License Number Expiration Date Cancel Date
PRINCIPAL LIFE INSURANCE COMPANY
12/15/2003 LHF406 07/10/2009

Authority

Description Issue Date Termination Date Status
HEALTH 12/01/2003 Active
LIFE 12/01/2003 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
7696209

Other Addresses

Address Type
ACRISURE LLC
20055 SW PACIFIC HWY STE 203
SHERWOOD, OR 97140-9294
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: 11/16/2025 11:33:32 PM