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:	HAMILTON
Business Address
Address 1:	409 E MONUMENT AVE
Address 2:	STE 400
City:	DAYTON
State:	OH
Zip:	45402
Phone:	513-338-5767
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	409 E MONUMENT AVE
Address 2:	STE 400
City:	DAYTON
State:	OH
Zip:	45402
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
CARRIE TAYLOR	PRODUCER	7526162	YES		04/10/2018
TAMMY BOGAN	ACCOUNT ASSISTANT	17135972	YES		04/18/2018
JEANETTE DAWES	ACCOUNT MANAGER	7997144	YES		04/02/2018

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:	SHARON FOGELMAN
Title:	LICENSING COORDINATOR
Phone Number:	513-338-5767
Email Address:	SHARON.FOGELMAN@MMA-MW.COM