Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO, LLC
Incorporation / Formation Date:
FEIN:	80-0786940
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	3900 KINROSS LAKES PARKWAY, #300
Address 2:
City:	RICHFIELD
State:	OH
Zip:	44286
Phone:	4403339000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3900 KINROSS LAKES PARKWAY, #300
Address 2:
City:	RICHFIELD
State:	OH
Zip:	44286
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
SHARON KLINE	AGENT	520185	YES		6-1-17
LORI HAGAR	AGENT	1822401	YES		6-1-17
KIMBERLY KAY PETERSON	AGENT	18330438	YES		6-1-17
DOUGLAS DONAUGH	AGENT	1746730	YES		4-1-17
KATRINA CONRAD-KING	AGENT	5653783		YES	4-7-17
STEVEN POLOUS	AGENT	2834270		YES	5-15-17

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:	ANGELA N. DROOK, ESQ.
Title:	ASSISTANT SECRETARY
Phone Number:	440-333-9000
Email Address:	ADROOK@ASSUREDPARTNERSOH.COM