Notification of Changes for Business Entity
General Information  
Business Entity Name: PVI AGENCY, LLC
Incorporation / Formation Date:  
FEIN: 611725907
Ohio License Number: 1040983
NPN: 17293683
DBA / Trade Name:  
State of Domicile: TX
County: DALLAS
Business Address  
Address 1: 400 N. ST. PAUL STREET, SUITE 505
Address 2:  
City: DALLAS
State: TX
Zip: 75201
Phone: 2144325577
Fax:  
Business Web Site Address:  
Business Email Address: JAMES.LANSHE@VALUEINSURED.COM
Mailing Address  
Address 1: 400 N. ST. PAUL STREET, SUITE 505
Address 2:  
City: DALLAS
State: TX
Zip: 75201
   
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
           
Members, Owners, Partners, Officers and Directors
Name Title Identifying # Add Delete Eff. Date
JOSEPH MELENDEZ CEO AND DIRECTOR/MANAGING MEMB 071483532 YES   05/16/2018
JAMES LANSHE EVP & GENERAL COUNSEL 192365999 YES   05/16/2018
STEVEN MELENDEZ CFO/ DIRECTOR/MANAGING MEMBER 086620106 YES   05/16/2018
EDWARD ELLIS DIRECTOR 464663885 YES   05/16/2018
PAUL KNEUER DIRECTOR 146587685 YES   05/16/2018
HOUSTON INSURANCE GROUP MEMBER 14-1957288 YES   05/16/2018
MT WHITNEY SECURITIESLLC MEMBER 22-2005057 YES   05/16/2018
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: JANIE SELLERS
Title: COMPLIANCE SPECIALIST
Phone Number: 2547296136
Email Address: JSELLERS@ILSAINC.COM