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	1/31/2025
Active	Resident	Agent	Property	2/6/2001	1/31/2025
Active	Resident	Agent	Health	11/2/1999	1/31/2025
Active	Resident	Agent	Life	11/2/1999	1/31/2025
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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	11/15/2024	01/31/2025

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
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
Active	Bristol West Insurance Company	301655	Agent - Casualty	2/11/2008
Active	Bristol West Insurance Company	301655	Agent - Property	2/11/2008
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
Active	Designated Agent Company Inc.	681257	Agent - Life	12/12/2013
Active	Designated Agent Company Inc.	681257	Agent - Health	12/12/2013
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