Notification of Changes for Business Entity
General Information
Business Entity Name:	MARSH & MCLENNAN AGENCY LLC
Incorporation / Formation Date:
FEIN:	26-3237576
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CLERMONT
Business Address
Address 1:	6279 TRI-RIDGE BLVD, STE 400
Address 2:
City:	LOVELAND
State:	OH
Zip:	45140
Phone:	513-338-5767
Fax:
Business Web Site Address:
Business Email Address:	SHARON.FOGELMAN@MMA-MW.COM
Mailing Address
Address 1:	6279 TRI-RIDGE BLVD, STE 400
Address 2:
City:	LOVELAND
State:	OH
Zip:	45140
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
CRAIG CAREY	PRODUCER	17696212	YES		06/01/2017
CAMERON NEIHEISEL		285-98-6026	YES		06/28/2017
SHAWN STINE	PRODUCER	8392782	YES		06/28/2017
NATALIE HENNINGSEN	ACCOUNT ASSISTANT	17003965	YES		07/17/2017
KENDRA CROSS	BILLING/ENROLLMENT SPECIALIST	402-49-3275	YES		07/17/2017
ALFONSO MARISCO	I I HAVE NO ADDITIONAL ON	2051772		YES
DIANA IVEY	THESE TERMINATED EMPLOYEES.			YES
HELEN A ANTOINE	PLEASE DELEE THEM FROM THE			YES
JAMIE ESQUIVEL	CORP STRUCTURE.			YES
JEFFTREY PENNY				YES
JOHN VAN MAREN STOCK				YES
JOSEPH K SHERRILL				YES
JUDD MICHAEL WAGNER				YES
KATHLEEN JUDITH VANDERSLICE				YES
KATRINA E UNGER				YES

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:	NICHOLAS BERTKE
Title:	EXEC VP
Phone Number:	513-338-5767
Email Address:	SHARON.FOGELMAN@MMA-MW.COM