Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO DBA DAWSON INSURANCE
Incorporation / Formation Date:
FEIN:	80-0786940
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	1340 DEPOT STREET
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	44116
Phone:	440-333-9000
Fax:
Business Web Site Address:
Business Email Address:	INFO@DAWSON.COM
Mailing Address
Address 1:	1430 DEPOT STREET
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	44116
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
DARREN FAYE	AGENT	1924536	YES		3-31-16
DONALD RICHARD EMCH	AGENT	17118742	YES		3-31-16
TODD GROH	AGENT	2772618	YES		3-31-16
ALEX HOOSER	AGENT	17445294	YES		3-31-16
GERALD JONES	AGENT	1205179	YES		3-31-16
KENNETH KLUBNIK	AGENT	625186	YES		3-31-16
SUSAN KOTHE	AGENT	7703512	YES		3-31-16
JANET KRAPF	AGENT	2225837	YES		3-31-16
EVAN LAUBE	AGENT	17771456	YES		3-31-16
DANIEL LITTLE	AGENT	2775751	YES		3-31-16
MARGARET MAUREEN LOESER	AGENT	16209760	YES		3-31-16
CINDA L. MEYER	AGENT	2266711	YES		3-31-16
DMITRIY MIKIN	AGENT	17129167	YES		3-31-16
JOHN MITCHELL	AGENT	1924012	YES		3-31-16
PAMELA MUZILLA	AGENT	2341618	YES		3-31-16

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 DROOK
Title:	SECRETARY
Phone Number:	440-895-6338
Email Address:	A