Notification of Changes for Business Entity
General Information
Business Entity Name:	MARSH & MCLENNAN AGENCY - MIDWEST
Incorporation / Formation Date:
FEIN:	26-3237576
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CLERMONT
Business Address
Address 1:	409 E. MONUMENT AVE.
Address 2:	SUITE 400
City:	DAYTON
State:	OH
Zip:	45402
Phone:	937-228-4135
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	409 E. MONUMENT AVE.
Address 2:	SUITE 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
BILLIE RIEGLE	EMPLOYEE	11590642		YES	4/12/17
CECILE BOECKMAN	EMPLOYEE	2441158		YES	4/12/17
COLLEEN EHRET	AGENT	2227869		YES	4/12/17
HEATHER RENEE JACKSON	AGENT	17886523		YES	4/12/17
JANET MCCABE	EMPLOYEE	3236055		YES	4/12/17
JUDITH BEILHARZ	AGENT	278643709		YES	4/12/17

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
CHRISTOPHER MCATEE	OFFICER	2343157		YES	4/12/17

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