Individual Information

CLARK D MANTZ

LAS VEGAS, NV 89118

Active

clark.mantz.b5kv@statefarm.com

02/09/1987

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Res. Producer/Producer Firm	21452	10/01/2001	Active	10/01/2001	06/30/2028

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	10/01/2001	Active	10/01/2001
Health	10/01/2001	Active	10/01/2001
Life	10/01/2001	Active	10/01/2001
Property	10/01/2001	Active	10/01/2001
Var. Annuities/Var. Life	10/01/2001	Active	10/01/2001
Casualty	02/09/1987	Inactive	10/01/2001
Health	02/09/1987	Inactive	10/01/2001
Life	02/09/1987	Inactive	10/01/2001
Property	02/09/1987	Inactive	10/01/2001
Surety	02/09/1987	Inactive	01/01/2020
Surety	10/01/2001	Inactive	01/01/2020
Var. Annuities/Var. Life	06/25/1998	Inactive	10/01/2001

Company Name	Appointment Type	Status	Active Date
105464
AMERICAN PET INSURANCE COMPANY	Property	Active	01/19/2021
897
Company Name	Appointment Type	Status	Active Date
JACKSON NATIONAL LIFE INSURANCE COMPANY	Life	Active	03/25/2021
	Var. Annuities/Var. Life	Active	03/25/2021
166815
Company Name	Appointment Type	Status	Active Date
STATE FARM CLASSIC INSURANCE COMPANY	Casualty	Active	03/11/2026
	Property	Active	03/11/2026
613
Company Name	Appointment Type	Status	Active Date
STATE FARM FIRE & CASUALTY COMPANY	Casualty	Active	03/18/2020
	Property	Active	03/18/2020
615
Company Name	Appointment Type	Status	Active Date
STATE FARM LIFE INSURANCE COMPANY	Life	Active	03/18/2020
	Var. Annuities/Var. Life	Active	03/18/2020
616
Company Name	Appointment Type	Status	Active Date
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY	Casualty	Active	03/18/2020
	Health	Active	03/18/2020
	Property	Active	03/18/2020

row(s) 1 - 12 of 12

Organization	Association Type	Type	Beg dte	End dte
CLARK D MANTZ INSURANCE AGENCY INC	Designated Resp Lic Prdcr	Agency	04/17/2020	-

1 - 1