Notification of Changes for Business Entity
General Information  
Business Entity Name: WELLS FARGO INSURANCE, INC.
Incorporation / Formation Date:  
FEIN: 410587845
Ohio License Number: 23765
NPN: 654461
DBA / Trade Name:  
State of Domicile: MN
County: HENNEPIN
Business Address  
Address 1: 550 S 4TH STREET
Address 2:  
City: MINNEAPOLIS
State: MN
Zip: 55415
Phone: 612.667.3931
Fax:  
Business Web Site Address:  
Business Email Address: WFIILICENSING@WELLSFARGO.COM
Mailing Address  
Address 1: 550 S 4TH STREET
Address 2:  
City: MINNEAPOLIS
State: MN
Zip: 55415
   
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
JOSHUA VALEAD PRODUCER 17765801   YES 02/08/2018
JOSE VELAZQUEZ MARTINEZ PRODUCER 16835954   YES 02/08/2018
TIMOTHY WIDEL PRODUCER 8874370   YES 02/08/2018
CRAIG WILLIAMS PRODUCER 17381841   YES 02/08/2018
TIMOTHY WOOD PRODUCER 16171636   YES 02/08/2018
SEAN WOODS PRODUCER 6725900   YES 02/08/2018
THOMAS WOODWARD PRODUCER 17528330   YES 02/08/2018
JAMES YELECK PRODUCER 15915732   YES 02/08/2018
           
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: SHARMAINE ECKARD
Title: LICENSING COORDINATOR
Phone Number: 612.667.3931
Email Address: SHARMAINE.ECKARD@WELLSFARGO.COM