Notification of Changes for Business Entity
General Information
Business Entity Name:	KEYCORP INSURANCE AGENCY USA, INC.
Incorporation / Formation Date:
FEIN:	31-1438300
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	USA
Business Address
Address 1:	4900 TIEDEMAN RD
Address 2:
City:	BROOKLYN
State:	OH
Zip:	44144
Phone:	216.813.
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4900 TIEDEMAN ROAD
Address 2:
City:	BROOKLYN
State:	OH
Zip:	44144
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
APRIL WALKER	AGENT	7982732		YES	03/15/2018
CATHERINE CALLARD	AGENT	11599347		YES	03/15/2018
CHAD SHUHERK	AGENT	0000		YES	03/15/2018
GREG CHOINSKI	AGENT	15693360		YES	03/15/2018
JAMES VARNER	AGENT	8680186		YES	03/15/2018
JANE FRANKART	AGENT	8481640		YES	03/15/2018
JENNA GORDON	AGENT	18028955		YES	03/15/2018
JENNIFER GROMOSKY	AGENT	17431654		YES	03/15/2018
JENNIFER GAUKIN	AGENT	8582442		YES	03/15/2018
JESSICA MOORE	AGENT	9049406		YES	03/15/2018
KANDI QUINT	AGENT	17288651		YES	03/15/2018
KATRINA O'SULLIVAN	AGENT	13864916	YES		03/15/2018
KERI DRAIN	AGENT	8677533		YES	03/15/2018
MICHAEL WOLTERMAN	AGENT	8186498		YES	03/15/2018
OMAR KALIM	AGENT	8595		YES	03/15/2018

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:	JOANN DETZEL
Title:	LICENSING SPECIALIST
Phone Number:	216.813.7904
Email Address: