Notification of Changes for Business Entity
General Information  
Business Entity Name: INTERSECURITIES INS AGENCY INC
Incorporation / Formation Date:  
FEIN: 42-1517005
Ohio License Number:
NPN:
DBA / Trade Name:  
State of Domicile: CA
County: LOS ANGELES
Business Address  
Address 1: 660 S. FIGUEROA STREET
Address 2:  
City: LOS ANGELES
State: CA
Zip: 90017
Phone: 7704539300
Fax:  
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 11315 JOHNS CREEK PARKWAY
Address 2:  
City: DULUTH
State: GA
Zip: 30097
   
Indicate the type of change you are seeking
Address Change: YES
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
HARVEY KORFIN EMPLOYEE 558073   YES 7/17/2018
HELEN J DAVIS AGENT 79871   YES 7/17/2018
DAVID A GOLDISH AGENT 13352   YES 7/17/2018
GEORGE J MAKRIS EMPLOYEE 16835   YES 7/17/2018
WILLIAM P DAVIS AGENT 13518   YES 7/17/2018
VICTOR MANUEL SANCHEZ AGENT 1099185 YES   7/17/2018
           
Members, Owners, Partners, Officers and Directors
Name Title Identifying # Add Delete Eff. Date
VICTOR MANUEL SANCHEZ DRLP 1099185 YES   7/17/2018
HARVEY KORFIN DRLP 558073   YES 7/17/2018
WILLIAM H GEIGER SECRETARY 000000   YES 7/17/2018
THOMAS R MORIARTY PRESIDENT 000000   YES 7/17/2018
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) 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: PATRICIA JONES
Title: SR. LICENSING SPECIALIST
Phone Number: 7704539300
Email Address: PATRICIA.JONES@TRANSAMERICA.COM