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:	OH
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
BROWN, RASHAWN	PRODUCER	16482314	YES		12/28/2016
BRUNO, MARGARITA	PRODUCER	16376129	YES		12/28/2016
BRYANT, JASON S	PRODUCER	12491039	YES		12/28/2016
BULLUCK, ORLANDO	PRODUCER	17261706	YES		12/28/2016
BURKE, CONNIE T	PRODUCER	8879322	YES		12/28/2016
CANFIELD, CAROL	PRODUCER	17063503	YES		12/28/2016
CAPONI, RICHARD W	PRODUCER	989720	YES		12/28/2016
CHAMBERS, MEGHAN PEARLE	PRODUCER	17442610	YES		12/28/2016
COCHRANE, MICHELLE DENISE	PRODUCER	7656112	YES		12/28/2016
COLLINS, LISA MARYANN	PRODUCER	7940396	YES		12/28/2016
DE BERRY, ANDROMADA	PRODUCER	16613434	YES		12/28/2016
FOREMAN, HASSAN DARRYL	PRODUCER	16307511	YES		12/28/2016
GAUDETTE, SHERRY LYNNE	PRODUCER	3147414	YES		12/28/2016
GIBSON, FREDDIE	PRODUCER	6607365	YES		12/28/2016
HERRERA AGUSTINIANO, RAMIRO	PRODUCER	17024161	YES		12/28/2016

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