DEPARTMENT OF INSURANCE

Name	Jack Clark Insurance, LLC	DOIID	968265	NAIC NPN	18541463

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Life	9/18/2017	3/31/2025
Active	Resident	Agent	Property	9/18/2017	3/31/2025
Active	Resident	Agent	Casualty	9/18/2017	3/31/2025
Active	Resident	Agent	Health	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

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Business / Home Office	211 S Washington Street Clinton, KY 42031

Phone Information

Type	Phone
Business / Home Office	(270) 653-3701