DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Smith, Kelly Sue	DOIID	342877	NAIC NPN	7188334

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Adjuster	Independent	6/14/1996	11/9/1998
Inactive	Non Resident	Agent	Health	9/17/2012	1/31/2015
Inactive	Resident	Apprentice Adjuster	Not Applicable	6/6/1995	6/6/1996
* 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
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/17/2012	12/13/2012
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/17/2012	12/13/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Administrative Services Corporation	394874	Adjuster - Independent	6/14/1996	11/9/1998

Sponsored By

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Marzian, William F	360025	Apprentice Adjuster - Not Applicable	6/6/1995	6/6/1996