DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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	Property	9/18/2017		3/31/2027
Active	Resident	Agent	Casualty	9/18/2017		3/31/2027
Active	Resident	Agent	Life	9/18/2017		3/31/2027
Active	Resident	Agent	Health	9/18/2017		3/31/2027
Denied	Resident	Agent	Crop
* 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
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