Notification of Changes for Business Entity
General Information
Business Entity Name:	JBWBDP, INC.
Incorporation / Formation Date:
FEIN:	06-0867210
Ohio License Number:	29644
NPN:	1997827
DBA / Trade Name:
State of Domicile:	CT
County:	NEW LONDON
Business Address
Address 1:	15 LIBERTY WAY
Address 2:
City:	NIANTIC
State:	CT
Zip:	06357
Phone:	860-739-3322
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	15 LIBERTY WAY
Address 2:
City:	NIANTIC
State:	CT
Zip:	06357
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	SMITH INS INC
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	JOHN M BUDDS
Title:	PRESIDENT/TREASURER
Phone Number:	860-739-3322
Email Address:	MMEENEGHAN@SMITHINS.COM