Notification of Changes for Business Entity
General Information
Business Entity Name:	EVARTS TREMAINE
Incorporation / Formation Date:
FEIN:	340210170
Ohio License Number:	1322
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	1111 SUPERIOR AVE STE 420
Address 2:
City:	CLEVELAND
State:	OH
Zip:	44114
Phone:	2166217183
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1111 SUPERIOR AVE STE 420
Address 2:
City:	CLEVELAND
State:	OH
Zip:	44114
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
MARY LASKO	ACCOUNT MANAGER	8733944	YES		8/22/2016

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:	ALISON COVINGTON
Title:	OFFICE ADMINISTRATOR
Phone Number:	2166217183
Email Address:	AJCOVINGTON@EVARTSTREMAINE.COM