Notification of Changes for Business Entity
General Information
Business Entity Name:	SEEMAN HOLTZ PROPERTY & CASUALTY INC
Incorporation / Formation Date:
FEIN:	47-4626961
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	PALM BEACH
Business Address
Address 1:	301 YAMATO ROAD
Address 2:	SUITE 2250
City:	BOCA RATON
State:	FL
Zip:	33431
Phone:	561-451-1900
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	301 YAMATO ROAD
Address 2:	SUITE 2250
City:	BOCA RATON
State:	FL
Zip:	33431
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
KAREN ALLEN-MURPHY	EMPLOYEE	17099678	YES		09-06-2018
ADAM GWALTNEY	EMPLOYEE	3314738	YES		09-06-2018
ERIC REDMAN	EMPLOYEE	15646443	YES		09-06-2018
JENNIFER RITMAN	EMPLOYEE	365921	YES		09-06-2018

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:	KARI SMITH
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	KNSMITH@SUPPORTIVEIS.COM