Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO DBA DAWSON INSURANCE
Incorporation / Formation Date:
FEIN:	80-0786940
Ohio License Number:	954553
NPN:	16553081
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	1340 DEPOT STREET
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	44116
Phone:	440-333-9000
Fax:	440-356-2126
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1430 DEPOT STREET
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	4
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
ANTHONY M. GIELTY	AGENT	745846		YES	5-13-16
TAMI M. TONATHY	AGENT	54793		YES	5-13-16
DEBRA J. BAIRD	AGENT	1072844	YES		4-10-16
MARY GRACE BINDREITER	AGENT	1087083	YES		4-10-16
TRAVIS BISCILLA	AGENT	1056693	YES		4-10-16
MELISSA CARR	AGENT	274302	YES		4-30-16
ORQUIDIA CARRION	AGENT	63231	YES		4-30-16
HEATHER CHEETHAM	AGENT	64964	YES		4-30-16
KATRINIA CONRAD-KING	AGENT	586460	YES		4-30-16
MARY COOK	AGENT	46855	YES		4-30-16
AURORA COONEY	AGENT	638181	YES		4-30-16
PAUL CRUCIANI	AGENT	21044	YES		4-30-16
KIM A. DEGIRALOMO	AGENT	21154	YES		4-30-16
DIANA MICHELLE DRAHOS	AGENT	717259	YES		4-30-16
DIANA BETH DUNN	AGENT	1021216	YES		4-30-16

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ROBERT W. LAMPUS	SECRETARY	16604		YES	4-30-16
ANGELA NICOLE DROOK	SECRETYAR	654146	YES		4-30-16

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:	ANGELA DROOK
Title:	SECRETARY
Phone Number:	440-895-6338
Email Address:	ADROOK@DAWSONCOMPANIES.COM