Notification of Changes for Business Entity
General Information
Business Entity Name:	FRONTIER INSURANCE AGENCY INC.
Incorporation / Formation Date:	12/19/1984
FEIN:	31-1121390
Ohio License Number:	5097
NPN:	1875065
DBA / Trade Name:
State of Domicile:	OH
County:	WASHINGTON
Business Address
Address 1:	38370 OHIO STATE ROUTE 7
Address 2:
City:	NEWPORT
State:	OH
Zip:	45768
Phone:	7404732740
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 620
Address 2:
City:	NEWPORT
State:	OH
Zip:	45768
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
SHANE A WILKS	PRODUCER	1140500	YES		02/12/2018
JOSH C HUMBLE	PRODUCER	830181	YES		02/12/2018
DAVID L PROFITT	PRODUCER	1164394	YES		02/12/2018
LYDIA M WELLS	PRODUCER	1149046	YES		02/12/2018

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:	ROY L STANLEY
Title:	PRESIDENT
Phone Number:	7404732740
Email Address:	ROY.STANLEY@STANLEYINSURANCEINC.COM