Notification of Changes for Business Entity
General Information
Business Entity Name:	THE GENERAL AUTOMOBILE INS SVCS INC
Incorporation / Formation Date:
FEIN:	62-1684225
Ohio License Number:	36214
NPN:	6539339
DBA / Trade Name:
State of Domicile:	CA
County:	SAN BERNARDINO
Business Address
Address 1:	4141 E INLAND EMPIRE BLVD #290
Address 2:
City:	ONTARIO
State:	OH
Zip:	91764
Phone:	800-280-1466
Fax:
Business Web Site Address:	WWW.THEGENERAL.COM
Business Email Address:	MBARNETT@THEGENERAL.COM
Mailing Address
Address 1:	2636 ELM HILL PIKE
Address 2:
City:	NASHVILLE
State:	OH
Zip:	37214
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
STRAYHAN, MARK ALLAN	PRODUCER	16960239	YES		12/28/2016
TURNER, AJA	PRODUCER	17560625	YES		12/28/2016
VALLEE, GERMAINE MONIQUE	PRODUCER	16810759	YES		12/28/2016
VENABLE, CHARLES G	PRODUCER	4789726	YES		12/28/2016
WOLKONOWSKI, MICHAEL	PRODUCER	8656008	YES		12/28/2016
ANDROVETT, DEREK R	PRODUCER	17079977	YES		12/28/2016
PEZZANO, DAVID MICHAEL	PRODUCER	15903251	YES		12/28/2016
HOONAN, KEARA ANNE	PRODUCER	16461921	YES		12/28/2016
MIXON, MICHAEL RAY	PRODUCER	16522917	YES		12/28/2016
WEAVER, DANIEL ALLAN	PRODUCER	11212914	YES		12/28/2016
MCCALLIE, LEILANI G	PRODUCER	16869430	YES		12/28/2016
COUGHLIN, MICHAEL G	PRODUCER	14346331	YES		12/28/2016
JUDKINS, KATHRYN M	PRODUCER	16998557	YES		12/28/2016
WILLIAMS, ZACHARY R	PRODUCER	16949684	YES		12/28/2016
CATALUNA, ANDREW A	PRODUCER	17029460	YES		12/28/2016

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:	MEGAN BARNETT
Title:	LICENSING ADMIN
Phone Number:	800-257-0263 #3248
Email Address:	MBARNETT@THEGENERAL.COM