DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Derek William	DOIID	984709	NAIC NPN	18622063

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	2/15/2018	4/30/2022
Inactive	Non Resident	Agent	Property	2/15/2018	4/30/2022
* 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 Guarantee and Liability Insurance Company	301216	Agent - Casualty	3/7/2018	4/30/2022
Inactive	American Guarantee and Liability Insurance Company	301216	Agent - Property	3/7/2018	4/30/2022
Inactive	American Zurich Insurance Company	300592	Agent - Casualty	3/7/2018	4/30/2022
Inactive	American Zurich Insurance Company	300592	Agent - Property	3/7/2018	4/30/2022
Inactive	Zurich American Insurance Company	301121	Agent - Casualty	3/7/2018	4/30/2022
Inactive	Zurich American Insurance Company	301121	Agent - Property	3/7/2018	4/30/2022
Inactive	Zurich American Insurance Company of Illinois	301805	Agent - Casualty	3/7/2018	4/30/2022
Inactive	Zurich American Insurance Company of Illinois	301805	Agent - Property	3/7/2018	4/30/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Mercedes-Benz Insurance Agency, LLC	660058	Agent - Property	3/7/2018	4/30/2022
Inactive	Mercedes-Benz Insurance Agency, LLC	660058	Agent - Casualty	3/7/2018	4/30/2022