Notification of Changes for Business Entity
General Information
Business Entity Name:	THE HILB GROUP OF INDIANA, LLC
Incorporation / Formation Date:
FEIN:	814056122
Ohio License Number:
NPN:
DBA / Trade Name:	BKC INSURANCE SERVICES
State of Domicile:	IN
County:	JOHNSON
Business Address
Address 1:	3209 W SMITH VALLEY RD STE 112
Address 2:
City:	GREENWOOD
State:	IN
Zip:	46142
Phone:	7654536704
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3209 W SMITH VALLEY RD STE 112
Address 2:
City:	GREENWOOD
State:	IN
Zip:	46142
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
CATHERINE MCCREADY	CSA	1065735	YES		01/01/2018

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:	SARA JOHNSTON
Title:	ADMINISTRATIVE SERVICES
Phone Number:	2316274381
Email Address:	SJOHNSTON@BKCINSURANCE.COM