Notification of Changes for Business Entity
General Information
Business Entity Name:	BRATRUD MIDDLETON INSURANCE BROKERS INC
Incorporation / Formation Date:	01/01/1968
FEIN:	91-0830024
Ohio License Number:	27702, 38865
NPN:	686766
DBA / Trade Name:	PROPEL INSURANCE
State of Domicile:	WA
County:	PIERCE
Business Address
Address 1:	1201 PACIFIC AVE STE 1000
Address 2:
City:	TACOMA
State:	WA
Zip:	98402
Phone:	2537592200
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 2940
Address 2:
City:	TACOMA
State:	WA
Zip:	98401
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
JANET DUNCAN	EMPLOYEE	825648	YES		5/1/16

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:	VICKIE HAMILTON
Title:	LICENSING COORDINATOR
Phone Number:	2537592200
Email Address:	VICKIE.HAMILTON@PROPELINSURANCE.COM