Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF OHIO, LLC
Incorporation / Formation Date:
FEIN:	80-0786940
Ohio License Number:	954553
NPN:	16553081
DBA / Trade Name:	DBA DAWSON INSURANCE
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	1340 DEPOT STREET
Address 2:	#300
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:	SAME AS ABOVE
Address 2:
City:	SAME AS ABOVE
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
SUSAN COEN ROWLAND	AGENT	4592846		YES	11-17-16
JANET KRAPF	AGENT	2225837		YES	11-20-16

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:	ASSISTANT SECRETARY
Phone Number:	440-333-9000
Email Address:	ADROOK@DAWSONCOMPANIES.COM