Notification of Changes for Business Entity
General Information
Business Entity Name:	KIBBLE & PRENTICE HOLDING COMPANY
Incorporation / Formation Date:	5/25/1982
FEIN:	911176315
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	WA
County:	KING
Business Address
Address 1:	601 UNION STREET
Address 2:	SUITE 1000
City:	SEATTLE
State:	WA
Zip:	98101
Phone:	206-441-6300
Fax:
Business Web Site Address:
Business Email Address:	TONYA.STONE@KPCOM.COM
Mailing Address
Address 1:	4357 249TH AVE SE
Address 2:
City:	ISSAQUAH
State:	WA
Zip:	98029
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
TONYA R. STONE	PRODUCER	5765413	YES		9/7/2017

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)	NO
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?	NO
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:	JOSEPH HAYMAN
Title:	COMPLIANCE INTERN
Phone Number:	2065775563
Email Address:	LICENSING@USI.COM