Notification of Changes for Business Entity
General Information
Business Entity Name:	EXP INSURANCE AGENCY, INC.
Incorporation / Formation Date:	09/15/2003
FEIN:	71-0952339
Ohio License Number:	30583
NPN:
DBA / Trade Name:
State of Domicile:	MO
County:	ST. LOUIS
Business Address
Address 1:	600 CORPORATE PARK DRIVE
Address 2:
City:	ST. LOUIS
State:	MO
Zip:	63105
Phone:	314-512-2865
Fax:
Business Web Site Address:
Business Email Address:	WILLIAM.J.KELLER@EFLEETS.COM
Mailing Address
Address 1:	600 CORPORATE PARK DRIVE
Address 2:
City:	ST. LOUIS
State:	MO
Zip:	63105
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
BONNIE GOMEZ	PRODUCER	17821523	YES		05/05/2016

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:	DEANNA STANLEY
Title:	PRESIDENT OF KLS
Phone Number:	214-855-0737
Email Address:	DSTANLEY@KENNEDYLICENSING.COM