Notification of Changes for Business Entity
General Information
Business Entity Name:	THE GENERAL AUTOMOBILE INS SVCS INC
Incorporation / Formation Date:
FEIN:	62-1684225
Ohio License Number:	36214
NPN:	6539339
DBA / Trade Name:
State of Domicile:	CA
County:	SAN BERNARDINO
Business Address
Address 1:	4141 E INLAND EMPIRE BLVD #290
Address 2:
City:	ONTARIO
State:	OH
Zip:	91764
Phone:	800-280-1466
Fax:
Business Web Site Address:	WWW.THEGENERAL.COM
Business Email Address:	MBARNETT@THEGENERAL.COM
Mailing Address
Address 1:	2636 ELM HILL PIKE
Address 2:
City:	NASHVILLE
State:	TN
Zip:	37214
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
LEISNER, JAMES ROBERT	PRODUCER	17740109	YES		12/27/2016
LUGO, VICTORIA LYNN	PRODUCER	13021769	YES		12/27/2016
LUSK, NIKI ELAINE	PRODUCER	2676696	YES		12/27/2016
MENDOZA, BARBARA ANN	PRODUCER	6746515	YES		12/27/2016
MEYER, RYAN ANDREW	PRODUCER	17438351	YES		12/27/2016
MILLER, GIAMMODA LEWIS	PRODUCER	16781513	YES		12/27/2016
MONTNEY, WILLIAM FORREST	PRODUCER	6741996	YES		12/27/2016
MOODY, ERIK MARCEL	PRODUCER	8582263	YES		12/27/2016
MORALES, HILARIO GILBERTO	PRODUCER	10838966	YES		12/27/2016
MORRIS, TRACY JEROME	PRODUCER	16204913	YES		12/27/2016
NADON, DONALD BRIAN	PRODUCER	1435918	YES		12/27/2016
ORENDAY, MARIA ANTONIA	PRODUCER	17282209	YES		12/27/2016
PADILLA, ANTHONY JOSEPH	PRODUCER	13399996	YES		12/27/2016
POLK, CYNDEE ANN	PRODUCER	7244942	YES		12/27/2016
PORRAS, JUAN ALBERTO	PRODUCER	17057886	YES		12/27/2016

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:	MEGAN BARNETT
Title:	LICENSING ADMIN
Phone Number:	800-257-0263 #3248
Email Address:	MBARNETT@THEGENERAL.COM