DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Michelle L	DOIID	687097	NAIC NPN	6766590

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	8/6/2019	5/31/2026
Active	Non Resident	Agent	Property	8/6/2019	5/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/13/2024	5/31/2026
* 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 Guarantee and Liability Insurance Company	301216	Agent - Casualty	2/6/2024
Active	American Guarantee and Liability Insurance Company	301216	Agent - Property	2/6/2024
Inactive	American Interstate Insurance Company	301092	Agent - Casualty	11/13/2008	5/31/2016
Inactive	American Interstate Insurance Company	301092	Agent - Property	11/13/2008	5/31/2016
Active	American Zurich Insurance Company	300592	Agent - Casualty	2/6/2024
Active	American Zurich Insurance Company	300592	Agent - Property	2/6/2024
Inactive	Atain Insurance Company	681449	Agent - Casualty	11/1/2022	1/25/2024
Inactive	Atain Insurance Company	681449	Agent - Property	11/1/2022	1/25/2024
Inactive	Berkshire Hathaway Homestate Insurance Company	709249	Agent - Casualty	5/2/2011	12/29/2015
Inactive	Berkshire Hathaway Homestate Insurance Company	709249	Agent - Property	5/2/2011	12/29/2015
Inactive	Capitol Indemnity Corporation	301030	Agent - Casualty	9/16/2009	5/31/2016
Inactive	Capitol Indemnity Corporation	301030	Agent - Property	9/16/2009	5/31/2016
Inactive	Commerce and Industry Insurance Company	300881	Agent - Casualty	9/22/2009	5/31/2016
Inactive	Commerce and Industry Insurance Company	300881	Agent - Property	9/22/2009	5/31/2016
Inactive	Mount Vernon Fire Insurance Company	301397	Agent - Casualty	8/26/2008	5/31/2016
Inactive	Mount Vernon Fire Insurance Company	301397	Agent - Property	8/26/2008	5/31/2016
Inactive	New Hampshire Insurance Company	301670	Agent - Casualty	9/22/2009	5/31/2016
Inactive	New Hampshire Insurance Company	301670	Agent - Property	9/22/2009	5/31/2016
Inactive	Silver Oak Casualty, Inc.	517101	Agent - Casualty	11/13/2008	11/23/2010
Inactive	Silver Oak Casualty, Inc.	517101	Agent - Property	11/13/2008	11/23/2010
Inactive	Underwriters at Lloyd's, London	300658	Agent - Casualty	7/18/2014	5/31/2016
Inactive	Underwriters at Lloyd's, London	300658	Agent - Property	7/18/2014	5/31/2016
Active	Zurich American Insurance Company	301121	Agent - Casualty	2/6/2024
Active	Zurich American Insurance Company	301121	Agent - Property	2/6/2024
Active	Zurich American Insurance Company of Illinois	301805	Agent - Casualty	2/6/2024
Active	Zurich American Insurance Company of Illinois	301805	Agent - Property	2/6/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Burns & Wilcox Ltd	525929	Agent - Casualty	7/28/2023	10/10/2023
Inactive	Burns & Wilcox Ltd	525929	Agent - Property	7/28/2023	10/10/2023
Active	CRC Ins Services, LLC	502276	Agent - Casualty	2/20/2024
Active	CRC Ins Services, LLC	502276	Agent - Property	2/20/2024
Denied	RSG Specialty, LLC	726176	Agent - Casualty
Denied	RSG Specialty, LLC	726176	Agent - Property