Notification of Changes for Business Entity
General Information
Business Entity Name:	CONSUMERS UNIFIED INSURANCE AGENCY, LLC
Incorporation / Formation Date:
FEIN:	823630586
Ohio License Number:	1177758
NPN:	18653592
DBA / Trade Name:
State of Domicile:	OK
County:	TULSA
Business Address
Address 1:	601 S. BOULDER AVE. 16TH FL.
Address 2:
City:	TULSA
State:	OK
Zip:	74119
Phone:	6177901723
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	601 S. BOULDER AVE. 16TH FL.
Address 2:
City:	TULSA
State:	OK
Zip:	74119
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
PAULINE HADDAD	CFO OF INSURAMATCH	125-82-4173	YES		01/22/2018
COLLEEN M. GRANAHAN	CFO OF INSURAMATCH	192-60-9837		YES	01/22/2018

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:	MARC V. BURO
Title:	CEO
Phone Number:	6177901723
Email Address:	CALICENSING@INSURAMATCH.COM