Individual Information

MIKE W SMITH

WAYNE, NJ 07470-4953

Active

msmith@axisins.com

07/31/2003

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	176185	07/31/2003	Active	07/31/2003	07/31/2024
Non-Res. Surplus Lines Broker	3516518	01/27/2020	Active	01/27/2020	01/31/2026

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	07/31/2003	Active	07/31/2003
Health	07/31/2003	Active	07/31/2003
Life	07/31/2003	Active	07/31/2003
Property	07/31/2003	Active	07/31/2003
Surplus Lines	01/27/2020	Active	01/27/2020

Company Name	Appointment Type	Status	Active Date
17
ACE AMERICAN INSURANCE COMPANY	Health	Active	01/31/2024
233
Company Name	Appointment Type	Status	Active Date
FEDERAL INSURANCE COMPANY	Health	Active	01/31/2024
1728
Company Name	Appointment Type	Status	Active Date
GREAT MIDWEST INSURANCE COMPANY	Casualty	Active	12/21/2017
	Property	Active	12/21/2017
1741
Company Name	Appointment Type	Status	Active Date
HUDSON INSURANCE COMPANY	Casualty	Active	12/12/2023
	Property	Active	12/12/2023
991
Company Name	Appointment Type	Status	Active Date
IMPERIUM INSURANCE COMPANY	Casualty	Active	07/17/2014
	Property	Active	07/17/2014
693
Company Name	Appointment Type	Status	Active Date
UNITED STATES LIABILITY INSURANCE COMPANY	Casualty	Active	12/05/2013
	Property	Active	12/05/2013

row(s) 1 - 10 of 10

Organization	Association Type	Type	Beg dte	End dte
AXIS INSURANCE SERVICES LLC	Designated Resp Lic Prdcr	Agency	09/16/2020	-
PL RISK ADVISORS INC	Designated Resp Lic Prdcr	Agency	05/14/2020	-
PLRISK SPECIALTY INSURANCE AGENCY LLC	Designated Resp Lic Prdcr	Agency	03/20/2023	-

1 - 3