Notification of Changes for Business Entity
General Information
Business Entity Name:	PARKERS STEVENS AGENCY, LLC
Incorporation / Formation Date:
FEIN:	39-2041981
Ohio License Number:	28219
NPN:	7343748
DBA / Trade Name:
State of Domicile:	WI
County:	PORTAGE
Business Address
Address 1:	1800 NORTH POINT DR
Address 2:
City:	STEVENS POINT
State:	WV
Zip:	54481
Phone:	800-248-4087
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1800 NORTH POINT DR
Address 2:
City:	STEVENS POINT
State:	WV
Zip:	54481
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
NOELIA ALTAGRACIA ABREU	DIRECT SALES REP	15776064	YES		2/20/2018
JASON ALAN BEST	DIRECT SALES REP	7113009	YES		2/20/2018
AMANDA KATHERYN CARTER	DIRECT SALES REP	17326837	YES		2/20/2018
EMMANUEL VLADIMIR FLORES	DIRECT SALES REP	17769627	YES		2/20/2018
MICHAEL JOSEPH MCCONNELL	DIRECT SALES REP	2442576	YES		2/20/2018
REBECA A MISHLER	DIRECT SALES REP	6726911	YES		2/20/2018
LORI ANN MEWS	DIRECT SALES REP	13454937	YES		2/20/2018
THOMAS C MOORE	DIRECT SALES REP	18407843	YES		2/20/2018
BRETT RIEDEL	DIRECT SALES REP	17377950	YES		2/20/2018
FELICIA MARIE SALVINSKI	DIRECT SALES REP	12455506	YES		2/20/2018
KIM J MARTIN	DIRECT SALES REP	4560070	YES		2/20/2018
JENA M LAWSON	DIRECT SALES REP	17074236	YES		2/20/2018

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)
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:	NANCY PETRUSKA
Title:	SUPPORT SUPERVISOR
Phone Number:	715-346-7383
Email Address:	NANCY.PETRUSKA@SENTRY.COM