DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Blake P	DOIID	847177	NAIC NPN	17335952

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Casualty	9/30/2014		9/30/2024
Active	Resident	Agent	Health	10/18/2016		9/30/2024
Active	Resident	Agent	Life	10/4/2016		9/30/2024
Active	Resident	Agent	Property	9/23/2014		9/30/2024
* 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	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Shelter General Insurance Company	301109	Agent - Casualty	10/8/2014	5/2/2022
Inactive	Shelter General Insurance Company	301109	Agent - Property	10/8/2014	5/2/2022
Inactive	Shelter Life Insurance Company	300391	Agent - Health	10/27/2016	5/2/2022
Inactive	Shelter Life Insurance Company	300391	Agent - Life	10/27/2016	5/2/2022
Inactive	Shelter Mutual Insurance Company	301870	Agent - Casualty	10/8/2014	5/2/2022
Inactive	Shelter Mutual Insurance Company	301870	Agent - Property	10/8/2014	5/2/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Daniel Boone Agency, LLC.	515760	Agent - Casualty	10/8/2014	5/2/2022
Inactive	Daniel Boone Agency, LLC.	515760	Agent - Property	10/8/2014	5/2/2022