Individual Information

JEFFREY ADAM LIND

PORTLAND, ME 04104-3543

Active

jlind@clarkinsurance.com

11/20/2018

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3395881	11/20/2018	Active	11/20/2018	11/30/2024
Non-Res. Surplus Lines Broker	3639547	02/26/2021	Active	02/26/2021	02/29/2024

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	11/20/2018	Active	11/20/2018
Health	11/20/2018	Active	11/20/2018
Life	11/20/2018	Active	11/20/2018
Property	11/20/2018	Active	11/20/2018
Surplus Lines	02/26/2021	Active	02/26/2021

Company Name	Appointment Type	Status	Active Date
288
GREAT AMERICAN INSURANCE COMPANY	Casualty	Active	11/03/2021
	Property	Active	11/03/2021
469
Company Name	Appointment Type	Status	Active Date
HARTFORD UNDERWRITERS INSURANCE COMPANY	Casualty	Active	09/09/2021
	Property	Active	09/09/2021
1811
Company Name	Appointment Type	Status	Active Date
SENTINEL INSURANCE COMPANY LTD	Casualty	Active	09/05/2021
	Property	Active	09/05/2021
608
Company Name	Appointment Type	Status	Active Date
STANDARD FIRE INSURANCE COMPANY (THE)	Casualty	Active	05/29/2020
	Property	Active	05/29/2020
4
Company Name	Appointment Type	Status	Active Date
TRAVELERS CASUALTY AND SURETY COMPANY	Casualty	Active	05/29/2020
	Property	Active	05/29/2020
650
Company Name	Appointment Type	Status	Active Date
TRAVELERS INDEMNITY COMPANY (THE)	Casualty	Active	05/29/2020
	Property	Active	05/29/2020

row(s) 1 - 12 of 12

Organization	Association Type	Type	Beg dte	End dte
CLARK INSURANCE	Designated Resp Lic Prdcr	Agency	06/12/2020	-

1 - 1