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:
NPN:
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:
Business Web Site Address:
Business Email Address:	INFO@DAWSON.COM
Mailing Address
Address 1:	1430 DEPOT STREET
Address 2:
City:	ROCKY RIVER
State:	OH
Zip:	44116
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
ROBERT T. AILES	AGENT	2776100	YES		3-31-16
DEBRA J. BAIRD	AGENT	1925094	YES		3-31-16
MARY GRACE BINDREITER	AGENT	17775399	YES		3-31-16
TRAVIS ANDREW BISCELLA	AGENT	17512975	YES		3-31-16
MELISSA K. CARR	AGENT	3236501	YES		3-31-16
ORQUIDIA CARRION	TRAINER	1810143	YES		3-31-16
HEATHER CHEETHAM	AGENT	2229395	YES		3-31-16
KATRINA ANN CONRAD-KING	AGENT	5653783	YES		3-31-16
MARY L. COOK	AGENT	1849136	YES		3-31-16
KATHLEEN REDMON COOK	AGENT	8522761	YES		3-31-16
AURORA COONEY	AGENT	7900023	YES		3-31-16
PAUL CRUCIANI	AGENT	2831204	YES		3-31-16
KIM A. DEGIRALOMO	AGENT	2772443	YES		3-31-16
DIANA MICHELLE DRAHOS	AGENT	8945190	YES		3-31-16
DIANA BETH DUNN	AGENT	17223543	YES		3-31-16

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