DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Teresa Renee	DOIID	382421	NAIC NPN	7205623

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Casualty	8/15/2000	3/17/2006
Inactive	Resident	Agent	Health	11/22/1995	3/17/2006
Inactive	Resident	Agent	Property	8/15/2000	3/17/2006
Inactive	Resident	Agent	General Lines	2/22/1996	8/15/2000
Inactive	Resident	Agent	Life	11/22/1995	3/17/2006
* 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	Allstate Indemnity Company	300778	Agent - Casualty	1/14/2004	3/17/2006
Inactive	Allstate Indemnity Company	300778	Agent - Property	1/14/2004	3/17/2006
Inactive	Allstate Insurance Company	300773	Agent - Casualty	1/14/2004	3/17/2006
Inactive	Allstate Insurance Company	300773	Agent - Property	1/14/2004	3/17/2006
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Casualty	8/12/2005	3/17/2006
Inactive	Allstate Property and Casualty Insurance Company	300593	Agent - Property	8/12/2005	3/17/2006
Inactive	American Economy Insurance Company	300315	Agent - Casualty	8/15/2000	12/18/2003
Inactive	American Economy Insurance Company	300315	Agent - General Lines	11/1/1998	8/15/2000
Inactive	American Economy Insurance Company	300315	Agent - Property	8/15/2000	12/18/2003
Inactive	American Select Insurance Company	301229	Agent - Casualty	8/15/2000	10/28/2005
Inactive	American Select Insurance Company	301229	Agent - General Lines	5/6/1999	8/15/2000
Inactive	American Select Insurance Company	301229	Agent - Property	8/15/2000	10/28/2005
Inactive	American States Insurance Company	301230	Agent - Casualty	8/15/2000	3/17/2006
Inactive	American States Insurance Company	301230	Agent - General Lines	11/1/1998	8/15/2000
Inactive	American States Insurance Company	301230	Agent - Property	8/15/2000	3/17/2006
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	11/19/2003	10/14/2004
Inactive	Consolidated Insurance Company	300943	Agent - Property	11/19/2003	10/14/2004
Inactive	Countryway Insurance Company	300809	Agent - Casualty	8/15/2000	3/17/2006
Inactive	Countryway Insurance Company	300809	Agent - General Lines	11/13/1997	8/15/2000
Inactive	Countryway Insurance Company	300809	Agent - Property	8/15/2000	3/17/2006
Inactive	Everlake Life Insurance Company	300873	Agent - Health	1/14/2004	3/17/2006
Inactive	Everlake Life Insurance Company	300873	Agent - Life	1/14/2004	3/17/2006
Inactive	First National Insurance Company of America	301690	Agent - Casualty	8/15/2000	3/17/2006
Inactive	First National Insurance Company of America	301690	Agent - General Lines	3/19/1996	8/15/2000
Inactive	First National Insurance Company of America	301690	Agent - Property	8/15/2000	3/17/2006
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/10/2004	2/15/2006
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/10/2004	2/15/2006
Inactive	General Insurance Company of America	300261	Agent - Casualty	8/15/2000	3/17/2006
Inactive	General Insurance Company of America	300261	Agent - General Lines	3/19/1996	8/15/2000
Inactive	General Insurance Company of America	300261	Agent - Property	8/15/2000	3/17/2006
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	5/5/2003	11/8/2005
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	5/5/2003	11/8/2005
Inactive	Grange Insurance Company	300234	Agent - Casualty	5/5/2003	11/8/2005
Inactive	Grange Insurance Company	300234	Agent - Health	5/5/2003	3/17/2006
Inactive	Grange Insurance Company	300234	Agent - Property	5/5/2003	11/8/2005
Inactive	Grange Life Insurance Company	300128	Agent - Health	5/5/2003	11/8/2005
Inactive	Grange Life Insurance Company	300128	Agent - Life	5/5/2003	11/8/2005
Inactive	Guarantee Life Insurance Company	301560	Agent - Health	11/22/1995	9/8/2000
Inactive	Guarantee Life Insurance Company	301560	Agent - Life	11/22/1995	9/8/2000
Inactive	Indiana Insurance Company	301909	Agent - Casualty	11/19/2003	10/14/2004
Inactive	Indiana Insurance Company	301909	Agent - Property	11/19/2003	10/14/2004
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Health	4/18/1996	7/11/1999
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Life	4/18/1996	7/11/1999
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	9/8/2000	3/17/2006
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	9/8/2000	3/17/2006
Inactive	Kentucky National Insurance Company	301625	Agent - General Lines	3/15/1996	12/17/1999
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	11/19/2003	10/14/2004
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	11/19/2003	10/14/2004
Inactive	Ohio Farmers Insurance Company	301667	Agent - Casualty	8/15/2000	10/28/2005
Inactive	Ohio Farmers Insurance Company	301667	Agent - General Lines	2/22/1996	8/15/2000
Inactive	Ohio Farmers Insurance Company	301667	Agent - Property	8/15/2000	10/28/2005
Inactive	Peerless Insurance Company	301910	Agent - Casualty	11/19/2003	10/14/2004
Inactive	Peerless Insurance Company	301910	Agent - Property	11/19/2003	10/14/2004
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	8/15/2000	3/17/2006
Inactive	SAFECO Insurance Company of America	300159	Agent - General Lines	3/19/1996	8/15/2000
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	8/15/2000	3/17/2006
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	8/15/2000	3/17/2006
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - General Lines	3/19/1996	8/15/2000
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	8/15/2000	3/17/2006
Inactive	SAFECO National Insurance Company	300989	Agent - Casualty	8/15/2000	12/6/2004
Inactive	SAFECO National Insurance Company	300989	Agent - General Lines	3/19/1996	8/15/2000
Inactive	SAFECO National Insurance Company	300989	Agent - Property	8/15/2000	12/6/2004
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	8/15/2000	5/5/2003
Inactive	State Automobile Mutual Insurance Company	301824	Agent - General Lines	4/18/1996	8/15/2000
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	8/15/2000	5/5/2003
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	5/5/2003	11/8/2005
Inactive	Trustgard Insurance Company	300104	Agent - Health	5/5/2003	3/17/2006
Inactive	Trustgard Insurance Company	300104	Agent - Property	5/5/2003	11/8/2005
Inactive	Westfield Insurance Company	301950	Agent - Casualty	8/15/2000	10/28/2005
Inactive	Westfield Insurance Company	301950	Agent - General Lines	3/15/1996	8/15/2000
Inactive	Westfield Insurance Company	301950	Agent - Property	8/15/2000	10/28/2005
Inactive	Westfield National Insurance Company	301036	Agent - Casualty	8/15/2000	10/28/2005
Inactive	Westfield National Insurance Company	301036	Agent - General Lines	3/15/1996	8/15/2000
Inactive	Westfield National Insurance Company	301036	Agent - Property	8/15/2000	10/28/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Berryman Insurance Agency Inc.	398251	Agent - General Lines	2/7/2000	8/15/2000
Inactive	Berryman Insurance Agency Inc.	398251	Agent - Life	2/7/2000	3/17/2006
Inactive	Berryman Insurance Agency Inc.	398251	Agent - Health	2/7/2000	3/17/2006
Inactive	Berryman Insurance Agency Inc.	398251	Agent - Property	8/15/2000	3/17/2006
Inactive	Berryman Insurance Agency Inc.	398251	Agent - Casualty	8/15/2000	3/17/2006