DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Henry Russell	DOIID	309628	NAIC NPN	7159916

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	9/17/1982	8/1/2012
Inactive	Resident	Agent	Casualty	8/15/2000	8/1/2012
Inactive	Resident	Agent	Life	9/17/1982	8/1/2012
Inactive	Resident	Agent	General Lines	10/7/1982	8/15/2000
Inactive	Resident	Agent	Property	8/15/2000	8/1/2012
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	2/2/2006	8/29/2012
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	11/14/2005	2/12/2008
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	11/14/2005	2/12/2008
Denied	Progressive Northern Insurance Company	301378	Agent - Casualty
Denied	Progressive Northern Insurance Company	301378	Agent - Property
Inactive	Shelter General Insurance Company	301109	Agent - Casualty	8/15/2000	8/3/2012
Inactive	Shelter General Insurance Company	301109	Agent - General Lines	10/7/1982	8/15/2000
Inactive	Shelter General Insurance Company	301109	Agent - Property	8/15/2000	8/3/2012
Inactive	Shelter Life Insurance Company	300391	Agent - Health	9/17/1982	8/3/2012
Inactive	Shelter Life Insurance Company	300391	Agent - Life	9/17/1982	8/3/2012
Inactive	Shelter Mutual Insurance Company	301870	Agent - Casualty	8/15/2000	8/3/2012
Inactive	Shelter Mutual Insurance Company	301870	Agent - General Lines	10/7/1982	8/15/2000
Inactive	Shelter Mutual Insurance Company	301870	Agent - Property	8/15/2000	8/3/2012
Inactive	Time Insurance Company	300683	Agent - Health	3/2/1994	3/31/1997
Inactive	Time Insurance Company	300683	Agent - Life	3/2/1994	3/31/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Daniel Boone Agency, LLC.	515760	Agent - Life	4/19/2001	8/2/2012
Inactive	Daniel Boone Agency, LLC.	515760	Agent - Health	4/19/2001	8/2/2012
Inactive	Daniel Boone Agency, LLC.	515760	Agent - Property	8/15/2000	8/2/2012
Inactive	Daniel Boone Agency, LLC.	515760	Agent - Casualty	8/15/2000	8/2/2012