DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Jack Clark Insurance, LLC	DOIID	968265	NAIC NPN	18541463

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Life	9/18/2017		3/31/2025
Active	Resident	Agent	Health	9/18/2017		3/31/2025
Active	Resident	Agent	Casualty	9/18/2017		3/31/2025
Active	Resident	Agent	Property	9/18/2017		3/31/2025
Denied	Resident	Agent	Crop
* 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	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Casualty	9/28/2017
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Health	9/28/2017
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Property	9/28/2017
Active	Southern Farm Bureau Life Insurance Company	300909	Agent - Health	9/28/2017
Active	Southern Farm Bureau Life Insurance Company	300909	Agent - Life	9/28/2017

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Clark, Rollie Jackson	367781	Agent - Casualty	9/18/2017
Active	Clark, Rollie Jackson	367781	Agent - Health	9/18/2017
Active	Clark, Rollie Jackson	367781	Agent - Life	9/18/2017
Active	Clark, Rollie Jackson	367781	Agent - Property	9/18/2017