Notification of Changes for Business Entity
General Information
Business Entity Name:	INSURANCE PARTNERS AGENCY LLC
Incorporation / Formation Date:
FEIN:	341056653
Ohio License Number:	792
NPN:	2516483
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	26865 CENTER RIDGE RD.
Address 2:
City:	WESTLAKE
State:	OH
Zip:	44145
Phone:	8002295266
Fax:
Business Web Site Address:
Business Email Address:	CCOLE@SEIBERTKECK.COM
Mailing Address
Address 1:	26865 CENTER RIDGE RD.
Address 2:
City:	WESTLAKE
State:	OH
Zip:	44145
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
DARLENE K VOLL	AM	1734424		YES	2/28/2017
ALYSSA R ZOLLOS	AM	18136189		YES	5/5/2017
KURT J BARKDULL	PRODUCER	16662225		YES	6/7/2017
RITA J MESSNER	QCM	1734306		YES	8/30/2017
SARA M POETA	AM	17674050		YES	6/27/2017
RICHARD G ROZMAN	PRODUCER	2775768		YES	6/8/2017
LAURIE A SKINNER-JOHNSON	MARKETING	17025285		YES	6/23/2017
JEFFREY M BECKA	PRODUCER	17592387		YES	8/4/2017
CHRISTINE A GRIFFIN	AM	2776669		YES	9/19/2017
PATRICK J MUSCENTI	PRODUCER	8382970		YES	9/21/2017
STEPHANIE KINNEY-REBAR	AM	5907250		YES	9/26/2017
JULIE LEMONTE	AM	9075362		YES	10/2/2017
SABRINA L HOUGH	AM	1805237	YES		9/11/2017

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)	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:	CRYSTAL COLE
Title:	COMPLIANCE MANAGER
Phone Number:	330-867-3147
Email Address:	CCOLE@SEIBERTKECK.COM