Notification of Changes for Business Entity
General Information
Business Entity Name:	HAGERTY INSURANCE AGENCY LLC
Incorporation / Formation Date:	01/01/2010
FEIN:	880268247
Ohio License Number:	24109
NPN:	686949
DBA / Trade Name:
State of Domicile:	MI
County:	GRAND TRAVERSE
Business Address
Address 1:	141 RIVERS EDGE DR, STE 200
Address 2:
City:	TRAVERS CITY
State:	MI
Zip:	49684
Phone:	2319417477
Fax:
Business Web Site Address:
Business Email Address:
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
CAMERON ESTLICK	AGENT	18360258	YES		04/13/2017
CASSIDY DIDIER	AGENT	18360260	YES		04/13/2017
GARY MANSFIELD	AGENT	18360297	YES		04/13/2017
JESSICA CRAWFORD	AGENT	18360296	YES		04/13/2017
JORI WALSH	AGENT	18305340	YES		04/13/2017
LOGAN WILSON	AGENT	17521337	YES		04/13/2017
MARGARET PHILLIPS	AGENT	18360265	YES		04/13/2017
NICOLE BROWN	AGENT	17794894	YES		04/13/2017
NOELLE EVELAND	AGENT	16611650	YES		04/13/2017
RUTH EIPPER	AGENT	17756085	YES		04/13/2017
SAMUEL BICKEL	AGENT	17774500	YES		04/13/2017
SIERRA BARELA	AGENT	17365334	YES		04/13/2017
VALERIE SCHIMPFLE	AGENT	17279304	YES		04/13/2017
ALEXANDER TUCKER	AGENT	18322170	YES		04/13/2017
MATTHEW LEWIS	AGENT	9036283	YES		04/13/2017

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:	BETH BROOKS WEST
Title:	SR LIC ADMIN
Phone Number:	2319326827
Email Address:	BBROOKS@HAGERTY.COM