Notification of Changes for Business Entity
General Information
Business Entity Name:	ALMEA INSURANCE, INC.
Incorporation / Formation Date:	06062016
FEIN:	812664477
Ohio License Number:	1111064
NPN:	17961628
DBA / Trade Name:	MAJESTIC EAGLE AGENCY, INC.
State of Domicile:	WA
County:	CLARK
Business Address
Address 1:	201 NE PARK PLAZA DRIVE, STE. 293
Address 2:
City:	VANCOUVER
State:	WA
Zip:	98684
Phone:	360 694 7994
Fax:	360 694 8575
Business Web Site Address:	STAFF@ALMEAINSURANCE.COM
Business Email Address:	BWILSON@ALMEAINSURANCE.COM
Mailing Address
Address 1:	201 NE PARK PLAZA DRIVE, STE.293
Address 2:
City:	VANCOURVER
State:	WA
Zip:	98684
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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

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