Notification of Changes for Business Entity
General Information
Business Entity Name:	GEICO INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	521168724
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MD
County:	MONTGOMERY
Business Address
Address 1:	5260 WESTERN AVENUE
Address 2:
City:	CHEVY CHASE
State:	MD
Zip:	20815
Phone:	5402867132
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	ONE GEICO BLVD
Address 2:	LICENSING 2ND FLOOR
City:	FREDERICKSBURG
State:	VA
Zip:	22412
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
ASHLEY HUSTED	AGENT	18159345	YES		11/8/16
KEVIN KAVANAGH	AGENT	18159388	YES		11/8/16
KELLY KNICKERBOCKER	AGENT	18159413	YES		11/8/16
MATTHEW LEMAY	AGENT	18159399	YES		11/8/16
MALORIE BENNETT	AGENT	18159383	YES		11/8/16
JONATHAN BRANNEN	AGENT	18159340	YES		11/8/16
SHAWN BRUMFIELD	AGENT	18159410	YES		11/8/16
ROBERT BUSCH III	AGENT	18159381	YES		11/8/16
DERRICK CARR II	AGENT	18159405	YES		11/8/16
KRISTEN CICHOCKI	AGENT	18159377	YES		11/8/16
MICHAEL CIOPPI	AGENT	18159385	YES		11/8/16
JACOB FREUND	AGENT	18159411	YES		11/8/16

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:	CHRISTINE KOZIOL
Title:	LICENSING TECHNICIAN
Phone Number:	7162764480
Email Address:	LICENSINGR8@GEICO.COM