Notification of Changes for Business Entity
General Information
Business Entity Name:	GEICO INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	521168724
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MD
County:	MONTGOMERY
Business Address
Address 1:	5260 WESTERN AVENUE
Address 2:
City:	CHEVY CHASE
State:	MD
Zip:	20815
Phone:	5402867132
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	ONE GEICO BLVD
Address 2:	LICENSING 2ND FLOOR
City:	FREDERICKSBURG
State:	VA
Zip:	22412
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
COURTNEY KOBA	AGENT	18357585	YES		4/4/17
DONNA MEDINA	AGENT	18357559	YES		4/4/17
KENISHA MORGAN	AGENT	18357584	YES		4/4/17
SARA BOOI	AGENT	18356333	YES		4/4/17
NICOLE OPALINSKI	AGENT	18356349	YES		4/4/17
JAMES PAPIA	AGENT	18356381	YES		4/4/17
NICHOLAS SCICOLONE	AGENT	18356340	YES		4/4/17
ASHLEY RUCHALA	AGENT	17154089	YES		4/4/17
MARK PRZYBYSZEWSKI	AGENT	18356347	YES		4/4/17
ANALYN SOWICKI	AGENT	18356356	YES		4/4/17
DANIEL STOPA	AGENT	18356383	YES		4/4/17
HAILEY YOUNG	AGENT	18356321	YES		4/4/17
JULIAN GRIEGO	AGENT	18356350	YES		4/4/17

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:	CHRISTINE KOZIOL
Title:	LICENSING TECHNICIAN
Phone Number:	7162764480
Email Address:	LICENSINGR8@GEICO.COM