DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Shelton Allen	DOIID	775971	NAIC NPN	5928602

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	3/1/2012	6/30/2019
Inactive	Non Resident	Agent	Health	3/1/2012	6/30/2019
Inactive	Non Resident	Agent	Casualty	3/1/2012	6/30/2019
Inactive	Non Resident	Agent	Life	3/1/2012	6/30/2019
* 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	Fireman's Fund Insurance Company	301423	Agent - Casualty	8/3/2012	6/30/2019
Inactive	Fireman's Fund Insurance Company	301423	Agent - Property	8/3/2012	6/30/2019
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	3/16/2015	3/14/2017
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	3/16/2015	3/14/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Casualty
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Property
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Life
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Health