DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Latasha	DOIID	878798	NAIC NPN	16939303

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	5/26/2015	7/31/2020
Inactive	Non Resident	Agent	Casualty	5/26/2015	7/31/2020
Active	Non Resident	Independent Adjuster	Property & Casualty	12/16/2019		7/31/2026
* 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
Independent Adjuster	05/15/2024	07/31/2024	05/07/2024	05/07/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Casualty	5/26/2015	1/10/2019
Inactive	Auto Club Property-Casualty Insurance Company	650781	Agent - Property	5/26/2015	1/10/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	AFICS, Inc	1122840	Independent Adjuster - Property & Casualty	12/6/2023