DEPARTMENT OF INSURANCE

Affiliations

Name	Clark Jr, Rollie Jackson	DOIID	367781	NAIC NPN	7199238

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Casualty	2/6/2001	1/31/2027
Active	Resident	Agent	Life	11/2/1999	1/31/2027
Active	Resident	Agent	Health	11/2/1999	1/31/2027
Active	Resident	Agent	Property	2/6/2001	1/31/2027
Denied	Resident	Agent	General Lines
* 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
Active	American Modern Home Insurance Company	300791	Agent - Casualty	1/26/2023
Active	American Modern Home Insurance Company	300791	Agent - Property	1/26/2023
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Casualty	6/30/2020
Active	American Modern Property and Casualty Insurance Company	301954	Agent - Property	6/30/2020
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	5/8/2018	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	5/8/2018	11/14/2021
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	1/31/2025
Inactive	Assurity Life Insurance Company	301099	Agent - Health	9/28/2005	1/22/2009
Inactive	Assurity Life Insurance Company	301099	Agent - Life	9/28/2005	1/22/2009
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	2/11/2008	12/20/2024
Inactive	Bristol West Insurance Company	301655	Agent - Property	2/11/2008	12/20/2024
Active	Dairyland Insurance Company	301370	Agent - Casualty	3/1/2001
Active	FB Insurance Company (The)	301763	Agent - Casualty	7/17/2001
Denied	FB Insurance Company (The)	301763	Agent - General Lines
Active	FB Insurance Company (The)	301763	Agent - Property	7/17/2001
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	7/16/2004	12/20/2023
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	7/16/2004	12/20/2023
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	10/7/2004	12/28/2006
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	10/7/2004	12/28/2006
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	10/31/2005	12/30/2009
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	10/31/2005	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	9/19/2008	6/8/2011
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	9/19/2008	6/8/2011
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Casualty	2/6/2001
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Property	2/6/2001
Active	Southern Farm Bureau Life Insurance Company	300909	Agent - Health	11/2/1999
Active	Southern Farm Bureau Life Insurance Company	300909	Agent - Life	11/2/1999
Inactive	Victoria Fire & Casualty Company	300313	Agent - Casualty	5/2/2011	6/23/2017
Inactive	Victoria Fire & Casualty Company	300313	Agent - Property	5/2/2011	6/23/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/12/2013	2/13/2025
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/12/2013	2/13/2025
Active	Jack Clark Insurance, LLC	968265	Agent - Life	9/18/2017
Active	Jack Clark Insurance, LLC	968265	Agent - Health	9/18/2017
Active	Jack Clark Insurance, LLC	968265	Agent - Property	9/18/2017
Active	Jack Clark Insurance, LLC	968265	Agent - Casualty	9/18/2017
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Life	12/30/2003
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Health	12/30/2003
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Property	12/30/2003
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Casualty	12/30/2003