| Notification of Changes for Business Entity |
| General Information | |
| Business Entity Name: | FIFTH THIRD INSURANCE AGENCY |
| Incorporation / Formation Date: | |
| FEIN: | 31-1282942 |
| Ohio License Number: | |
| NPN: | |
| DBA / Trade Name: | |
| State of Domicile: | OH |
| County: | HAMILTON |
| Business Address | |
| Address 1: | 34 FOUNTAIN SQUARE PLAZA |
| Address 2: | |
| City: | CINCINNATI |
| State: | OH |
| Zip: | 45263 |
| Phone: | 513-534-7421 |
| Fax: | |
| Business Web Site Address: | |
| Business Email Address: | |
| Mailing Address | |
| Address 1: | 34 FOUNTAIN SQUARE PLAZA |
| Address 2: | |
| City: | CINCINNATI |
| State: | OH |
| Zip: | 45263 |
| | |
| 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 |
| TINA AMSHOFF | EMP. BENEFITS INS. ADVISOR | 1486350 | YES | | 11/12/2018 |
| CALLIE ATTEBERY | PERSONAL LINES ACCT. MGR. | 9273759 | YES | | 11/12/2018 |
| JANELLE BANKS | ACCOUNT MANAGER | 7407542 | YES | | 11/12/2018 |
| MOLLIE BEAN | EMP. BENEFITS INS. ADVISOR | 7736530 | YES | | 11/12/2018 |
| KATHLEEN BELL | ADMINISTRATIVE ASST. II | 18434966 | YES | | 11/12/2018 |
| DAN DAVIS | EMP. BENEFITS INS. ADVISOR | 1449647 | YES | | 11/12/2018 |
| JAMES DIGHERO | EMP. BENEFITS INS. ADVISOR | 1846558 | YES | | 11/12/2018 |
| WILLIAM GRAY | EMP. BENEFITS INS. ADVISOR | 13885930 | YES | | 11/12/2018 |
| MYRON HOBBS | EMP. BENEFITS INS. ADVISOR | 2116364 | YES | | 11/12/2018 |
| BRUCE KLINEMAN | INS. ADVISOR P & C | 1457753 | YES | | 11/12/2018 |
| MICHAEL MCGRAW | MANAGING DIR. INS. AGENCY SERV | 332502 | YES | | 11/12/2018 |
| MICHAEL MEINERS | EMP. BENEFITS INS. ADVISOR | 13454835 | YES | | 11/12/2018 |
| CAROLYN NABORS | ACCOUNT EXECUTIVE | 2341840 | YES | | 11/12/2018 |
| GARY NEACE | ACCOUNT ADVISOR ASSISTANT | 1891379 | YES | | 11/12/2018 |
| JOHN NEACE | MD, SALES & BUS. DEVEL. | 1095363 | YES | | 11/12/2018 |
| | | | | | |
| 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 | |