Notification of Changes for Business Entity
General Information
Business Entity Name:	CLEMENTS & CO.
Incorporation / Formation Date:	3/19/1957
FEIN:	520809479
Ohio License Number:	25438
NPN:	2229649
DBA / Trade Name:	CLEMENTS WORLDWIDE
State of Domicile:	DC
County:	DISTRICT OF COLUMBIA
Business Address
Address 1:	1301 K STREET, NW, SUITE 1200 WEST
Address 2:
City:	WASHINGTON
State:	DC
Zip:	20005
Phone:	8008720067
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1301 K STREET, NW, SUITE 1200 WEST
Address 2:
City:	WASHINGTON
State:	DC
Zip:	20005
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
BRIDGET HARRINGTON	ACCOUNT MANAGER	16444980		YES	07/25/2017

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:	APRIL DOAN
Title:	LICENSING
Phone Number:	2547296136
Email Address:	ADOAN@ILSAINC.COM