DEPARTMENT OF INSURANCE

Affiliations

Name	Siereveld, Clayton T	DOIID	647888	NAIC NPN	3240216

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	1/18/2007	11/30/2024
Active	Non Resident	Agent	Casualty	1/18/2007	11/30/2024
Active	Non Resident	Agent	Life	1/18/2007	11/30/2024
Active	Non Resident	Agent	Property	1/18/2007	11/30/2024
* 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	09/15/2024	11/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Alternative Insurance Corporation	301697	Agent - Casualty	2/27/2014	3/16/2021
Inactive	American Alternative Insurance Corporation	301697	Agent - Property	2/27/2014	3/16/2021
Active	American General Life Insurance Company	301585	Agent - Health	3/6/2014
Active	American General Life Insurance Company	301585	Agent - Life	3/6/2014
Inactive	American General Life Insurance Company of Delaware	301057	Agent - Health	4/20/2007	12/27/2012
Inactive	American General Life Insurance Company of Delaware	301057	Agent - Life	4/20/2007	12/27/2012
Active	Combined Insurance Company of America	301472	Agent - Health	3/25/2014
Active	Combined Insurance Company of America	301472	Agent - Life	3/25/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	4/9/2008	9/8/2010
Inactive	CompBenefits Insurance Company	301864	Agent - Health	4/9/2008	9/9/2010
Inactive	CompBenefits Insurance Company	301864	Agent - Life	4/9/2008	9/9/2010
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/21/2010	9/8/2010
Inactive	EMC National Life Company	300388	Agent - Health	3/27/2007	11/8/2012
Inactive	EMC National Life Company	300388	Agent - Life	3/27/2007	11/8/2012
Inactive	Employers Mutual Casualty Company	300202	Agent - Casualty	3/27/2007	9/15/2008
Inactive	Employers Mutual Casualty Company	300202	Agent - Property	3/27/2007	9/15/2008
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Casualty	3/27/2007	9/15/2008
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Property	3/27/2007	9/15/2008
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	4/9/2008	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Health	4/9/2008	9/9/2010
Inactive	Humana Insurance Company	301104	Agent - Life	4/9/2008	9/9/2010
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	12/18/2019
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	2/10/2021
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	12/18/2019
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	3/23/2007	11/16/2011
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	3/23/2007	11/16/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Kentucky Public Entity Programs Inc	400082	Agent - Life	3/20/2014
Active	Kentucky Public Entity Programs Inc	400082	Agent - Health	3/20/2014
Active	Kentucky Public Entity Programs Inc	400082	Agent - Property	2/27/2014
Active	Kentucky Public Entity Programs Inc	400082	Agent - Casualty	2/27/2014
Inactive	Medlink Inc	400721	Agent - Life	3/24/2008	12/27/2012
Inactive	Medlink Inc	400721	Agent - Health	3/24/2008	12/27/2012