DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Karen P	DOIID	340877	NAIC NPN	7187416

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Adjuster	Independent	8/12/2008	7/1/2010
Active	Resident	Agent	Property	11/15/2018		10/31/2024
Active	Resident	Agent	Casualty	11/15/2018		10/31/2024
Active	Resident	Staff Adjuster	Property & Casualty	7/1/2010		10/31/2024
* 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	08/15/2024	10/31/2024
Staff Adjuster	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Pet Insurance Company, Inc.	301240	Agent - Casualty	11/5/2021
Active	American Pet Insurance Company, Inc.	301240	Agent - Property	11/5/2021
Active	State Farm Fire and Casualty Company	301809	Agent - Casualty	11/21/2018
Active	State Farm Fire and Casualty Company	301809	Agent - Property	11/21/2018
Active	State Farm Mutual Automobile Insurance Company	301732	Agent - Casualty	11/21/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allstate Insurance Company	300773	Adjuster - Independent	3/28/1990	4/7/2008
Active	Lisa Sams Insurance and Financial Services, Inc.	608106	Agent - Casualty	10/17/2019
Active	Lisa Sams Insurance and Financial Services, Inc.	608106	Agent - Property	10/17/2019