DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Derrick	DOIID	1386655	NAIC NPN	21124529

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	2/26/2025		6/30/2026
Active	Non Resident	Agent	Casualty	2/26/2025		6/30/2026
* 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	04/15/2026	06/30/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	2/27/2025
Active	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	2/27/2025
Active	American Modern Home Insurance Company	300791	Agent - Casualty	3/10/2025
Active	American Modern Home Insurance Company	300791	Agent - Property	3/10/2025
Active	Bristol West Insurance Company	301655	Agent - Casualty	9/10/2025
Active	Bristol West Insurance Company	301655	Agent - Property	9/10/2025
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	9/10/2025
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	9/10/2025
Active	Homesite Insurance Company	301139	Agent - Casualty	2/27/2025
Active	Homesite Insurance Company	301139	Agent - Property	2/27/2025
Active	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	2/27/2025
Active	Homesite Insurance Company of the Midwest	874850	Agent - Property	2/27/2025
Active	Midvale Indemnity Company	300292	Agent - Property	2/27/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	4/23/2025
Active	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	4/23/2025