Notification of Changes for Business Entity
General Information
Business Entity Name:	AMERICAN INSURANCE AGENCIES DIRECT, INC
Incorporation / Formation Date:
FEIN:	262732860
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	FL
County:	SARASOTA
Business Address
Address 1:	5566 BROADCAST COURT
Address 2:
City:	LAKEWOOD RANCH
State:	FL
Zip:	34240
Phone:	941-954-5700
Fax:
Business Web Site Address:
Business Email Address:	HANI_RIHAN@MSN.COM
Mailing Address
Address 1:	5566 BROADCAST COURT
Address 2:
City:	LAKEWOOD RANCH
State:	FL
Zip:	34240
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
BARDALES, KENNETH	PRODUCER	16508494	YES		04/13/2016

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)	NO
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?	NO
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:	DANIEL GARAVUSO
Title:	DIRECTOR, COMPLIANCE
Phone Number:	8133971493
Email Address:	DGARAVUSO@HIIQUOTE.COM