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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	06/15/2025	08/31/2025

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
Inactive	Employers Insurance Company of Wausau	301813	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Employers Insurance Company of Wausau	301813	Agent - Property	9/4/2015	5/20/2025
Inactive	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	9/4/2015	5/20/2025
Inactive	First Liberty Insurance Corporation (The)	301060	Agent - Property	9/4/2015	5/20/2025
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
Inactive	LM Insurance Corporation	301061	Agent - Casualty	9/4/2015	5/20/2025
Inactive	LM Insurance Corporation	301061	Agent - Property	9/4/2015	5/20/2025
Inactive	Liberty Insurance Corporation	300444	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Liberty Insurance Corporation	300444	Agent - Property	9/4/2015	5/20/2025
Inactive	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Liberty Mutual Fire Insurance Company	301913	Agent - Property	9/4/2015	5/20/2025
Inactive	Liberty Mutual Insurance Company	301159	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Liberty Mutual Insurance Company	301159	Agent - Property	9/4/2015	5/20/2025
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
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	9/4/2015	5/20/2025
Inactive	Ohio Security Insurance Company	300622	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Ohio Security Insurance Company	300622	Agent - Property	9/4/2015	5/20/2025
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Casualty	9/4/2015	5/20/2025
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Property	9/4/2015	5/20/2025
Inactive	Peerless Insurance Company	301910	Agent - Casualty	9/4/2015	5/8/2025
Inactive	Peerless Insurance Company	301910	Agent - Property	9/4/2015	5/8/2025
Inactive	West American Insurance Company	301112	Agent - Casualty	9/4/2015	5/20/2025
Inactive	West American Insurance Company	301112	Agent - Property	9/4/2015	5/20/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Paychex Insurance Agency Inc	509469	Agent - Property	9/4/2015	5/20/2025
Inactive	Paychex Insurance Agency Inc	509469	Agent - Casualty	9/4/2015	5/20/2025