DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Samantha	DOIID	1238316	NAIC NPN	19828718

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	2/2/2024		10/31/2025
Active	Non Resident	Agent	Casualty	2/2/2024		10/31/2025
Inactive	Non Resident	Agent	Personal Lines	10/24/2022	10/31/2023
* 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	08/15/2025	10/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Church Mutual Insurance Company, S.I.	301554	Agent - Casualty	10/11/2024	10/17/2024
Inactive	Church Mutual Insurance Company, S.I.	301554	Agent - Property	10/11/2024	10/17/2024
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	6/7/2024	9/9/2024
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	6/7/2024	9/9/2024
Inactive	National General Insurance Company	300152	Agent - Casualty	2/5/2024	9/10/2024
Inactive	National General Insurance Company	300152	Agent - Property	2/5/2024	9/10/2024
Inactive	Progressive Direct Insurance Company	301379	Agent - Personal Lines	10/25/2022	1/23/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Affinity Brokerage, LLC	544886	Agent - Casualty	2/6/2024	8/19/2024
Inactive	Affinity Brokerage, LLC	544886	Agent - Property	2/6/2024	8/19/2024
Inactive	Direct General Insurance Agency Inc	1018980	Agent - Casualty	2/6/2024	8/19/2024
Inactive	Direct General Insurance Agency Inc	1018980	Agent - Property	2/6/2024	8/19/2024
Inactive	National General Ins Marketing Inc	621228	Agent - Casualty	2/6/2024	8/19/2024
Inactive	National General Ins Marketing Inc	621228	Agent - Property	2/6/2024	8/19/2024