Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO, LLC
Incorporation / Formation Date:	02/21/2012
FEIN:	80-0786940
Ohio License Number:	954553, 955770
NPN:	16553081
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	1340 DEPOT ST. #300
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	44116
Phone:	9736692301
Fax:
Business Web Site Address:
Business Email Address:	SLAWRENCE@JAMISONGROUP.COM
Mailing Address
Address 1:	1340 DEPOT ST. #300
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	44116
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	THE CHURCH AGENCY
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:	PAUL VREDENBURG
Title:	MANAGER
Phone Number:	9736692301
Email Address:	SLAWRENCE@JAMISONGROUP.COM