Individual Information

JOSHUA EDWARD CLARK

Address:

ALBUQUERQUE, NM 87123-1944

Status:

Active

Email:

josh@covertree.com

Date:

09/18/2018

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3375385	09/18/2018	Active	09/18/2018	09/30/2024
Non-Res. Surplus Lines Broker	3970041	12/21/2023	Active	12/21/2023	12/31/2026

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	02/25/2021	Active	02/25/2021
Health	02/25/2021	Active	02/25/2021
Life	09/18/2018	Active	09/18/2018
Property	02/25/2021	Active	02/25/2021
Surplus Lines	12/21/2023	Active	12/21/2023

Company Name	Appointment Type	Status	Active Date
104
AMERITAS LIFE INSURANCE CORPORATION	Life	Active	09/29/2020
200
Company Name	Appointment Type	Status	Active Date
CMFG LIFE INSURANCE COMPANY	Life	Active	11/18/2020
1143
Company Name	Appointment Type	Status	Active Date
PRINCIPAL NATIONAL LIFE INSURANCE COMPANY	Life	Active	09/25/2020

row(s) 1 - 3 of 3

Organization	Association Type	Type	Beg dte	End dte
Covertree Inc	Designated Resp Lic Prdcr	Agency	09/01/2022	-

1 - 1