Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO, LLC
Incorporation / Formation Date:	02/21/2012
FEIN:	80-0786940
Ohio License Number:	955770, 954553
NPN:	16553081
DBA / Trade Name:
State of Domicile:	OH
County:	SUMMIT
Business Address
Address 1:	3900 KINROSS LAKES PARKWAY #300
Address 2:
City:	RICHFIELD
State:	OH
Zip:	44286
Phone:	9736692301
Fax:
Business Web Site Address:
Business Email Address:	SLAWRENCE@JAMISONGROUP.COM
Mailing Address
Address 1:	3900 KINROSS LAKES PARKWAY #300
Address 2:
City:	RICHFIELD
State:	OH
Zip:	44286
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
KATRINA CONRAD-KING	PRODUCER	5653783	YES		03/16/2017
PAUL CRUCIANI	PRODUCER	2831204	YES		03/16/2017
HEATHER CHEETHAM	PRODUCER	2229395	YES		03/16/2017
KIM DEGIRALOMO	PRODUCER	2772443	YES		03/16/2017
ELAINE DUNN	PRODUCER	2831638	YES		03/16/2017
DARREN FAYE	PRODUCER	1924536	YES		03/16/2017
LEE FRAMER	PRODUCER	368555	YES		03/16/2017
THERESA GUISER	PRODUCER	2772309	YES		03/16/2017
GEORGIANNE HIPPLER	PRODUCER	2769495	YES		03/16/2017
DAVID INGALLS	PRODUCER	510710	YES		03/16/2017
PEGGY KREPS	PRODUCER	8215737	YES		03/16/2017
WALTER KLOOTS	PRODUCER	765540	YES		03/16/2017
ROBIN LOOMIS	PRODUCER	3321209	YES		03/16/2017
DOUGLAS MALCOLM	PRODUCER	511157	YES		03/16/2017
RICHARD MARTINDALE	PRODUCER	1000599	YES		03/16/2017

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:	ERIC ANDERSON
Title:	SVP
Phone Number:	9736692301
Email Address:	SLAWRENCE@JAMISONGROUP.COM