Notification of Changes for Business Entity
General Information  
Business Entity Name: ASSUREDPARTNERS OF OHIO, LLC
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: 3RD FLOOR
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: 1340 DEPOT STREET
Address 2: 3RD FLOOR
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: YES
   
Licensed Producers
Name Title NPN Add Delete Eff. Date
EDWARD MORRISON AGENT 1923438   YES 12-30-16
DOUGLAS TIMPE AGENT 2775889   YES 12-30-16
JAMES ALLEGA AGENT 16494239   YES 12-30-16
JANET KRAPF AGENT 2225837   YES 11-30-16
KAREN FUREY AGENT 3630125   YES 12-30-16
SUSAN COWEN ROWLAND AGENT 4592846   YES 11-17-16
RACHEL PHELAN AGENT 7124215   YES 12-28-16
           
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 N. DROOK, ESQ
Title: ASSISTANT SECRETARY
Phone Number: 440-895-6338
Email Address: ADROOK@DAWSONCOMPANIES.COM