Notification of Changes for Business Entity
General Information  
Business Entity Name: HAGERTY INSURANCE AGENCY
Incorporation / Formation Date:  
FEIN: 880268247
Ohio License Number: 24109
NPN:
DBA / Trade Name:  
State of Domicile: MI
County: GRAND TRAVERSE
Business Address  
Address 1: 141 RIVERS EDGE DR
Address 2: STE 200
City: TRAVERSE CITY
State: MI
Zip: 49684
Phone: 2319417477
Fax:  
Business Web Site Address:  
Business Email Address: MEBY@HAGERTY.COM
Mailing Address  
Address 1: PO BOX 87
Address 2:  
City: TRAVERSE CITY
State: MI
Zip: 49685
   
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
CHRISTINE SMITH AGENT 18777758 YES   05/15/2018
CHRISTOPHER BUNDY AGENT 18777779 YES   05/15/2018
CHARLES SCHUYLER AGENT 18777774 YES   05/15/2018
CORAL JONES AGENT 18777780 YES   05/15/2018
DOUGLAS MACPHERSON AGENT 18777772 YES   05/15/2018
JANET JANSEN AGENT 18777770 YES   05/15/2018
KAYLA BOOTON AGENT 18777776 YES   05/15/2018
MARK GROSS AGENT 18777795 YES   05/15/2018
MELINDA HUGO AGENT 18777608 YES   05/15/2018
MOLLY MURANKO AGENT 18777801 YES   05/15/2018
RACHEL BAUER AGENT 18777773 YES   05/15/2018
           
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)
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: MEAGAN EBY
Title: LICENSING COORDINATOR
Phone Number: 2319417477
Email Address: MEBY@HAGERTY.COM