DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Michelle L	DOIID	687097	NAIC NPN	6766590

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	8/6/2019	5/31/2026
Active	Non Resident	Agent	Property	8/6/2019	5/31/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	5/13/2024	5/31/2026
* 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	03/15/2026	05/31/2026
Surplus Lines Broker	03/15/2026	05/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Guarantee and Liability Insurance Company	301216	Agent - Casualty	2/6/2024
Active	American Guarantee and Liability Insurance Company	301216	Agent - Property	2/6/2024
Inactive	American Interstate Insurance Company	301092	Agent - Casualty	11/13/2008	5/31/2016
Inactive	American Interstate Insurance Company	301092	Agent - Property	11/13/2008	5/31/2016
Active	American Zurich Insurance Company	300592	Agent - Casualty	2/6/2024
Active	American Zurich Insurance Company	300592	Agent - Property	2/6/2024
Inactive	Atain Insurance Company	681449	Agent - Casualty	11/1/2022	1/25/2024
Inactive	Atain Insurance Company	681449	Agent - Property	11/1/2022	1/25/2024
Inactive	Berkshire Hathaway Homestate Insurance Company	709249	Agent - Casualty	5/2/2011	12/29/2015
Inactive	Berkshire Hathaway Homestate Insurance Company	709249	Agent - Property	5/2/2011	12/29/2015
Inactive	Capitol Indemnity Corporation	301030	Agent - Casualty	9/16/2009	5/31/2016
Inactive	Capitol Indemnity Corporation	301030	Agent - Property	9/16/2009	5/31/2016
Inactive	Commerce and Industry Insurance Company	300881	Agent - Casualty	9/22/2009	5/31/2016
Inactive	Commerce and Industry Insurance Company	300881	Agent - Property	9/22/2009	5/31/2016
Inactive	Mount Vernon Fire Insurance Company	301397	Agent - Casualty	8/26/2008	5/31/2016
Inactive	Mount Vernon Fire Insurance Company	301397	Agent - Property	8/26/2008	5/31/2016
Inactive	New Hampshire Insurance Company	301670	Agent - Casualty	9/22/2009	5/31/2016
Inactive	New Hampshire Insurance Company	301670	Agent - Property	9/22/2009	5/31/2016
Inactive	Silver Oak Casualty, Inc.	517101	Agent - Casualty	11/13/2008	11/23/2010
Inactive	Silver Oak Casualty, Inc.	517101	Agent - Property	11/13/2008	11/23/2010
Inactive	Underwriters at Lloyd's, London	300658	Agent - Casualty	7/18/2014	5/31/2016
Inactive	Underwriters at Lloyd's, London	300658	Agent - Property	7/18/2014	5/31/2016
Active	Zurich American Insurance Company	301121	Agent - Casualty	2/6/2024
Active	Zurich American Insurance Company	301121	Agent - Property	2/6/2024
Active	Zurich American Insurance Company of Illinois	301805	Agent - Casualty	2/6/2024
Active	Zurich American Insurance Company of Illinois	301805	Agent - Property	2/6/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Burns & Wilcox Ltd	525929	Agent - Casualty	7/28/2023	10/10/2023
Inactive	Burns & Wilcox Ltd	525929	Agent - Property	7/28/2023	10/10/2023
Active	Crc Insurance Services, LLC	502276	Agent - Casualty	2/20/2024
Active	Crc Insurance Services, LLC	502276	Agent - Property	2/20/2024
Denied	RSG Specialty, LLC	726176	Agent - Casualty
Denied	RSG Specialty, LLC	726176	Agent - Property