DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Kelly M	DOIID	887694	NAIC NPN	8681219

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	8/19/2015	8/31/2025
Active	Non Resident	Agent	Casualty	8/19/2015	8/31/2025
* 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 Fire and Casualty Company	300567	Agent - Casualty	9/4/2015	10/15/2021
Inactive	American Fire and Casualty Company	300567	Agent - Property	9/4/2015	10/15/2021
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	9/4/2015	4/26/2024
Inactive	Consolidated Insurance Company	300943	Agent - Property	9/4/2015	4/26/2024
Active	Employers Insurance Company of Wausau	301813	Agent - Casualty	9/4/2015
Active	Employers Insurance Company of Wausau	301813	Agent - Property	9/4/2015
Active	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	9/4/2015
Active	First Liberty Insurance Corporation (The)	301060	Agent - Property	9/4/2015
Inactive	Indiana Insurance Company	301909	Agent - Casualty	9/4/2015	2/3/2023
Inactive	Indiana Insurance Company	301909	Agent - Property	9/4/2015	2/3/2023
Active	LM Insurance Corporation	301061	Agent - Casualty	9/4/2015
Active	LM Insurance Corporation	301061	Agent - Property	9/4/2015
Active	Liberty Insurance Corporation	300444	Agent - Casualty	9/4/2015
Active	Liberty Insurance Corporation	300444	Agent - Property	9/4/2015
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	9/4/2015
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Property	9/4/2015
Active	Liberty Mutual Insurance Company	301159	Agent - Casualty	9/4/2015
Active	Liberty Mutual Insurance Company	301159	Agent - Property	9/4/2015
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	9/4/2015	4/26/2024
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	9/4/2015	4/26/2024
Active	Ohio Casualty Insurance Company	301492	Agent - Casualty	9/4/2015
Active	Ohio Casualty Insurance Company	301492	Agent - Property	9/4/2015
Active	Ohio Security Insurance Company	300622	Agent - Casualty	9/4/2015
Active	Ohio Security Insurance Company	300622	Agent - Property	9/4/2015
Active	Peerless Indemnity Insurance Company	571682	Agent - Casualty	9/4/2015
Active	Peerless Indemnity Insurance Company	571682	Agent - Property	9/4/2015
Active	Peerless Insurance Company	301910	Agent - Casualty	9/4/2015
Active	Peerless Insurance Company	301910	Agent - Property	9/4/2015
Active	West American Insurance Company	301112	Agent - Casualty	9/4/2015
Active	West American Insurance Company	301112	Agent - Property	9/4/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Paychex Insurance Agency Inc	509469	Agent - Property	9/4/2015
Active	Paychex Insurance Agency Inc	509469	Agent - Casualty	9/4/2015