Notification of Changes for Business Entity
General Information
Business Entity Name:	MARSH & MCLENNAN AGENCY LLC
Incorporation / Formation Date:
FEIN:	26-3237576
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CLERMONT
Business Address
Address 1:	6279 TRI-RIDGE BLVD, STE 400
Address 2:
City:	LOVELAND
State:	OH
Zip:	45140
Phone:	513-338-5767
Fax:
Business Web Site Address:
Business Email Address:	SHARON.FOGELMAN@MMA-MW.COM
Mailing Address
Address 1:	6279 TRI-RIDGE BLVD, STE 400
Address 2:
City:	LOVELAND
State:	OH
Zip:	45140
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
KAY GENTRY AMOS	PLEASE REMOVE ALL FROM CORP			YES
KEVIN MCLAUGHLIN	STRUCTURE. I HAVE NO INFO			YES
LELAND R LEE	OTHER THAN THE NAMES.			YES
LOIS SHARE				YES
MARCIA L MCCUNE				YES
MICHAEL BURTON MILLIGAN				YES
PATRICK STANLEY HANSON				YES
PETER LOWRY				YES
STAN LAVERNE LAMBERT				YES
TAMARA KAYE HENDERSON				YES
TIMMY R LAFALIER				YES
TRACIE SUZANNE TORMASI				YES
WILLIAM D JEATRAN				YES
WILLIAM EDWARD MURPHY				YES

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:	SHARON FOGELMAN
Title:	LI CENSING COORDINATOR
Phone Number:	513-338-5767
Email Address:	SHARON.FOGELMAN@MMA-MW.COM