DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark Jr, Samuel Wayne	DOIID	600212	NAIC NPN	1616151

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	12/21/2004		12/31/2024
Active	Non Resident	Agent	Property	12/21/2004		12/31/2024
* 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	10/15/2024	12/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Berkley Regional Insurance Company	300920	Agent - Casualty	1/28/2022
Active	Berkley Regional Insurance Company	300920	Agent - Property	1/28/2022
Active	United States Fire Insurance Company	582240	Agent - Casualty	12/14/2023
Active	United States Fire Insurance Company	582240	Agent - Property	12/14/2023
Active	WCF National Insurance Company	300727	Agent - Casualty	8/10/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Dale Barton Agency	765836	Agent - Casualty	10/5/2011
Active	Dale Barton Agency	765836	Agent - Property	10/5/2011
Active	Hub International Ins Services Inc	609910	Agent - Casualty	3/5/2024
Active	Hub International Ins Services Inc	609910	Agent - Property	3/5/2024