Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO
Incorporation / Formation Date:
FEIN:	452712331
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	SUMMIT
Business Address
Address 1:	3900 KINROSS LAKES PARKWAY, #300
Address 2:
City:	RICHFIELD
State:	OH
Zip:	44286
Phone:	440-333-9000
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
ANNAMARIE BARBATO	AGENT	2206418		YES	10-3-17
ROBERT A. GREVEY	AGENT	2776596	YES		1-1-18

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MICHAEL J. KMETZ	MANAGER	283527538		YES	1-1-18
CHRISTINE SOLITRO	MANAGER	297449999	YES		1-1-18

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
Title:	ASSISTANT SECRETARY
Phone Number:	440-896-6338
Email Address:	ADROOK@ASSUREDPARTNERSOH.COM