Notification of Changes for Business Entity
General Information  
Business Entity Name: PEOPLES INSURANCE AGENCY, LLC
Incorporation / Formation Date:  
FEIN: 311398962
Ohio License Number: 2671
NPN: 2212599
DBA / Trade Name:  
State of Domicile: OH
County: WASHINGTON
Business Address  
Address 1: 138 PUTNAM ST
Address 2:  
City: MARIETTA
State: OH
Zip: 45750
Phone: 740-376-7279
Fax:  
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 138 PUTNAM ST
Address 2:  
City: MARIETTA
State: OH
Zip: 45750
   
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
KATHLEEN LANESE PRODUCER 1805035 YES   10/02/2017
NANCY S CARPENTER AGENT 2261167 YES   10/02/2017
KATHERINE M ZION AGENT 3415617 YES   10/02/2017
MARA SIMICEVIC AGENT 11138408 YES   10/02/2017
CINDY M TROZZI AGENT 2206552 YES   10/02/2017
VICTORIA M DEETS AGENT 1866959 YES   10/02/2017
EASTERNBOGER & GOWER INS SERVI AGENCY 8339366 YES   10/02/2017
           
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: AMY JO MIRACLE
Title:
Phone Number: 740-376-7279
Email Address: AMYJO.MIRACLE@PEBO.COM