DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Lisa	DOIID	711821	NAIC NPN	10868689

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	2/24/2012	9/30/2014
Inactive	Non Resident	Agent	Casualty	2/24/2012	9/30/2014
Inactive	Non Resident	Agent	Health	8/20/2009	9/30/2014
Inactive	Non Resident	Agent	Life	8/20/2009	9/30/2014
* 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	American Family Home Insurance Company	301817	Agent - Casualty	10/18/2013	11/18/2013
Inactive	American Family Home Insurance Company	301817	Agent - Property	10/18/2013	11/18/2013
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	9/1/2009	9/30/2014
Inactive	CompBenefits Insurance Company	301864	Agent - Health	9/1/2009	12/7/2011
Inactive	CompBenefits Insurance Company	301864	Agent - Life	9/1/2009	12/7/2011
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	11/6/2009	6/11/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/21/2010	9/30/2014
Inactive	Everly Life Insurance Company	561641	Agent - Life	4/22/2010	11/16/2010
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	3/21/2012	10/25/2013
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	3/21/2012	10/25/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	3/1/2012	12/28/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	3/1/2012	12/28/2013
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/10/2012	9/30/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/1/2009	9/30/2014
Inactive	Humana Insurance Company	301104	Agent - Health	9/1/2009	9/30/2014
Inactive	Humana Insurance Company	301104	Agent - Life	9/1/2009	9/30/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/1/2009	9/30/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/1/2009	9/30/2014
Inactive	Independent Order of Foresters	300743	Agent - Life	12/9/2009	12/20/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/26/2010	9/30/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/26/2010	9/30/2014
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	9/4/2009	9/30/2014
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Health	9/8/2009	12/13/2012
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Life	9/8/2009	12/13/2012
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	9/1/2011	11/4/2011
Inactive	Pennsylvania Life Insurance Company	301321	Agent - Health	9/8/2009	3/31/2013
Inactive	Pennsylvania Life Insurance Company	301321	Agent - Life	9/8/2009	3/31/2013
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	5/3/2010	9/30/2014
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	5/3/2010	9/30/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/1/2011	6/21/2012
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/1/2011	6/21/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Wells Fargo Insurance Inc.	518950	Agent - Life	3/7/2012	11/15/2013
Inactive	Wells Fargo Insurance Inc.	518950	Agent - Property	3/7/2012	11/15/2013
Inactive	Wells Fargo Insurance Inc.	518950	Agent - Casualty	3/7/2012	11/15/2013