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:	TN
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
BACA, JULIE	PRODUCER	6739927	YES		12/27/2016
BRANDT, JOSHUA MICHAEL	PRODUCER	2779456	YES		12/27/2016
BRITTAIN, SABRINA MARIE	PRODUCER	16836962	YES		12/27/2016
BRZOSKA, SHELBY LYNN	PRODUCER	17597727	YES		12/27/2016
CONS, ZACHARY ALEXANDER	PRODUCER	17337613	YES		12/27/2016
DELACRUZ, JAVIER A	PRODUCER	7637821	YES		12/27/2016
DUNN, GARY ALAN	PRODUCER	6721848	YES		12/27/2016
ERGER, JEREMY JAMES	PRODUCER	15427732	YES		12/27/2016
FARRELL, SHAUN MICHAEL	PRODUCER	17437195	YES		12/27/2016
GUILLEN PALOMINO, DEREK	PRODUCER	17747318	YES		12/27/2016
GULLY, LAMOND ADRAIN	PRODUCER	16984017	YES		12/27/2016
HALLETT, TRAVIS	PRODUCER	8825550	YES		12/27/2016
HARDY, ROBERT DUANE	PRODUCER	17051498	YES		12/27/2016
HEATH, LAURA J	PRODUCER	17809106	YES		12/27/2016
KING, LOIS ANN	PRODUCER	7931318	YES		12/27/2016

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