<?xml version="1.0" encoding="utf-8"?>
<DataSet SchemaVersion="1.4" ReportingState="FL" SubmissionType="AgentSS" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
	<Brokerage>
		<LicenseNumber>L123456</LicenseNumber>
		<Name>SMITH INSURANCE AGENCY</Name>
		<Contacts>
			<Contact ContactType="SubmissionContact">
				<FirstName>John</FirstName>
				<LastName>Adams</LastName>
				<EmailAddress>myemail@miscdomain.com</EmailAddress>
				<ContactAddress>
					<Address>1212 Douglas Ave</Address>
					<City>Orlando</City>
					<StateCode>FL</StateCode>
					<PostalCode>32903</PostalCode>
					<CountryCode>USA</CountryCode>
				</ContactAddress>
				<PhoneNumber>
					<AreaCode>407</AreaCode>
					<Prefix>555</Prefix>
					<Line>5555</Line>
				</PhoneNumber>
				<Fax>4075555556</Fax>
			</Contact>
			<Contact ContactType="BillingContact">
				<FirstName>John</FirstName>
				<LastName>Adams</LastName>
				<EmailAddress>myemail@miscdomain.com</EmailAddress>
				<ContactAddress>
					<Address>1212 Douglas Ave</Address>
					<City>Orlando</City>
					<StateCode>FL</StateCode>
					<PostalCode>32903</PostalCode>
					<CountryCode>USA</CountryCode>
				</ContactAddress>
				<PhoneNumber>
					<AreaCode>407</AreaCode>
					<Prefix>555</Prefix>
					<Line>5555</Line>
				</PhoneNumber>
				<Fax>4075551212</Fax>
			</Contact>
		</Contacts>
	</Brokerage>
	<BrokerPolicies>
		<BrokerPolicy>
			<Broker>
				<LicenseNumber>A123456</LicenseNumber>
				<BrokerInfo>
					<FirstName>ALEX</FirstName>
					<LastName>SMITH</LastName>
					<EmailAddress>myemail@miscdomain.com</EmailAddress>
					<BrokerAddress>
						<Address>1212 Douglas Ave</Address>
						<City>Orlando</City>
						<StateCode>FL</StateCode>
						<PostalCode>32903</PostalCode>
						<CountryCode>USA</CountryCode>
					</BrokerAddress>
					<MailingAddress>
						<Address>1212 Douglas Ave</Address>
						<City>Orlando</City>
						<StateCode>FL</StateCode>
						<PostalCode>32903</PostalCode>
						<CountryCode>USA</CountryCode>
					</MailingAddress>
					<PhoneNumber>
						<AreaCode>850</AreaCode>
						<Prefix>555</Prefix>
						<Line>1212</Line>
					</PhoneNumber>
				</BrokerInfo>
			</Broker>
			<Policies>
				<Policy Xml_PolicyID="3">
					<PolicyNumber>AAA00001</PolicyNumber>
					<ExpirationDate>2012-03-15</ExpirationDate>
					<InsuredName>INSUREDNAME001</InsuredName>
					<County>PALM BEACH</County>
					<PostalCode>33433</PostalCode>
					<Comment>INV:0000000</Comment>
					<Transactions>
						<Transaction Xml_TransactionID="3">
							<CoverageCode>1000</CoverageCode>
							<TaxStatus>0</TaxStatus>
							<TransactionType>1</TransactionType>
							<EffectiveDate>2011-03-15</EffectiveDate>
							<Insurer Xml_InsurerID="3">
								<Name>SCOTTSDALE INSURANCE COMPANY</Name>
								<NAICNumber>41297</NAICNumber>
							</Insurer>
							<IssueDate>2011-03-15</IssueDate>
							<Premium>4399.00</Premium>
							<PolicyFee>0.00</PolicyFee>
							<LateExempt>Y</LateExempt>
							<LateReason>C</LateReason>
						</Transaction>
					</Transactions>
				</Policy>
				<Policy Xml_PolicyID="5">
					<PolicyNumber>AAA00002</PolicyNumber>
					<ExpirationDate>2012-09-25</ExpirationDate>
					<InsuredName>INSUREDNAME002</InsuredName>
					<County>MIAMI-DADE</County>
					<PostalCode>33154</PostalCode>
					<Transactions>
						<Transaction Xml_TransactionID="5">
							<CoverageCode>1005</CoverageCode>
							<TaxStatus>0</TaxStatus>
							<TransactionType>1</TransactionType>
							<EffectiveDate>2011-09-25</EffectiveDate>
							<Insurer Xml_InsurerID="5">
								<Name>GENERAL STAR INDEMNITY COMPANY</Name>
								<NAICNumber>37362</NAICNumber>
							</Insurer>
							<IssueDate>2010-09-25</IssueDate>
							<Premium>2237.00</Premium>
							<PolicyFee>0.00</PolicyFee>
						</Transaction>
					</Transactions>
				</Policy>
				<Policy Xml_PolicyID="6">
					<PolicyNumber>AAA00003</PolicyNumber>
					<ExpirationDate>2012-07-19</ExpirationDate>
					<InsuredName>INSUREDNAME003</InsuredName>
					<County>PALM BEACH</County>
					<PostalCode>33408</PostalCode>
					<Transactions>
						<Transaction Xml_TransactionID="6">
							<CoverageCode>2003</CoverageCode>
							<TaxStatus>0</TaxStatus>
							<TransactionType>3</TransactionType>
							<EffectiveDate>2011-09-19</EffectiveDate>
							<HurricaneDeductible>2000</HurricaneDeductible>
							<WsCoverage>Y</WsCoverage>
							<WspEligible>Y</WspEligible>
							<AopDeductible>500</AopDeductible>
							<PrimaryAmount>200000</PrimaryAmount>
							<Insurer Xml_InsurerID="6">
								<Name>MOUNT VERNON FIRE INSURANCE COMPANY</Name>
								<NAICNumber>26522</NAICNumber>
							</Insurer>
							<IssueDate>2011-09-19</IssueDate>
							<Premium>-454.00</Premium>
							<PolicyFee>0.00</PolicyFee>
						</Transaction>
					</Transactions>
				</Policy>
				<Policy Xml_PolicyID="7">
					<PolicyNumber>AAA00004</PolicyNumber>
					<ExpirationDate>2012-07-12</ExpirationDate>
					<InsuredName>INSUREDNAME004</InsuredName>
					<County>BROWARD</County>
					<PostalCode>33073</PostalCode>
					<Transactions>
						<Transaction Xml_TransactionID="7">
							<CoverageCode>5000</CoverageCode>
							<TaxStatus>0</TaxStatus>
							<TransactionType>2</TransactionType>
							<EffectiveDate>2011-07-12</EffectiveDate>
							<Insurer Xml_InsurerID="7">
								<Name>BURLINGTON INSURANCE COMPANY, THE</Name>
								<NAICNumber>23620</NAICNumber>
							</Insurer>
							<IssueDate>2011-07-29</IssueDate>
							<Premium>180.00</Premium>
							<PolicyFee>0.00</PolicyFee>
						</Transaction>
					</Transactions>
				</Policy>
				<Policy Xml_PolicyID="9">
					<PolicyNumber>AAA00005</PolicyNumber>
					<ExpirationDate>2012-03-24</ExpirationDate>
					<InsuredName>INSUREDNAME005</InsuredName>
						<County>BROWARD</County>
						<PostalCode>33314</PostalCode>
					<Transactions>
						<Transaction Xml_TransactionID="9">
							<CoverageCode>5000</CoverageCode>
							<TaxStatus>0</TaxStatus>
							<TransactionType>5</TransactionType>
							<EffectiveDate>2011-03-24</EffectiveDate>
							<Insurer Xml_InsurerID="9">
                                <Name>LLOYD'S UNDERWRITERS AT, LONDON</Name>
                                <NAICNumber>AA1122000</NAICNumber>
							</Insurer>
							<IssueDate>2011-03-24</IssueDate>
							<Premium>1075.00</Premium>
							<PolicyFee>35.00</PolicyFee>
                            <UMR>B1234AAA00011</UMR>
                         </Transaction>
					</Transactions>
				</Policy>
			</Policies>
		</BrokerPolicy>
	</BrokerPolicies>
</DataSet>
