DEPARTMENT OF INSURANCE

Name	Smith, Jackie Wayne	DOIID	375252	NAIC NPN	548588

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Administrator	Not Applicable	3/25/1999	11/30/2015
Denied	Resident	Agent	Life
Denied	Resident	Agent	Health
Inactive	Resident	Agent	Casualty	8/12/2016	12/1/2017
Inactive	Resident	Agent	Property	8/12/2016	12/1/2017
Inactive	Resident	Agent	Health Maintenance Organization	8/17/1999	3/1/2001
Inactive	Resident	Agent	General Lines	3/2/1993	8/15/2000
Inactive	Resident	Surplus Lines Broker	Not Applicable	8/12/2016	11/30/2017

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Residence	Not Public Information
Business / Home Office	PBS Insurance Underwriting Corp. 6909 Timbersprings CircleLouisville, KY 40241
Mailing	6909 Timbersprings Circle Louisville, KY 40241

Internet Information

Type	Address
Business Email	pbs@pbsinsurance.com

Phone Information

Type	Phone
Business / Home Office	(502) 552-2453