Notification of Changes for Business Entity
General Information
Business Entity Name:	ATLAS INS AGCY INC
Incorporation / Formation Date:	12/13/1949
FEIN:	310530321
Ohio License Number:	4921
NPN:	1872936
DBA / Trade Name:
State of Domicile:	OH
County:	CLERMONT
Business Address
Address 1:	7000 MIDLAND BLVD
Address 2:
City:	AMELIA
State:	OH
Zip:	45102
Phone:	800-643-7770
Fax:
Business Web Site Address:
Business Email Address:	SHULL@AMIG.COM
Mailing Address
Address 1:	PO BOX 688
Address 2:
City:	AMELIA
State:	OH
Zip:	45102
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
CHRISTINE M. WILLARD	ASSISTANT VICE PRESIDENT	8732805	YES		05/10/2018
SHARON EPLING	ASSISTANT VICE PRESIDENT	15670900		YES	05/10/2018
MARY LOVELACE	ASSISTANT VICE PRESIDENT	8523951		YES	05/10/2018
CHRISTINE M. WILLARD	RDA	8732805	YES		05/10/2018
SHARON EPLING	RDA	15670900		YES	05/10/2018
MARY LOVELACE	RDA	8523951		YES	05/10/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
KENNETH LEO KUHN	SECRETARY/TREASURER	299644089		YES	05/10/2018
CHARLES SCHUSTER GRIFFITH III	SECRETARY	300584576	YES		05/10/2018
JAMES EDWARD HINKLE III	TREASURER	271842464	YES		05/10/2018
MATTHEW RYAN FONG	ASSISTANT SECRETARY	269804968	YES		05/10/2018
CATHERINE BOSTICK SMITH	DIRECTOR	245025638	YES		05/10/2018

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:	SHARRE N. HULL
Title:	TECHNICAL ANALYST II
Phone Number:	513-947-6076
Email Address:	SHULL@AMIG.COM