Notification of Changes for Business Entity
General Information
Business Entity Name:	BISHOP-SCOVELL INS AGENCY LLC
Incorporation / Formation Date:	10/30/2001
FEIN:	31-1772595
Ohio License Number:	26844
NPN:	6406022
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	5991 CHANDLER COURT, SUITE A
Address 2:
City:	WESTERVILLE
State:	OH
Zip:	43082
Phone:	614-794-4820
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1200 GRAHAM ROAD
Address 2:
City:	CUYAHOGA FALLS
State:	OH
Zip:	44224
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
KATHY THUENER	AGENT	2772280	YES		08/30/2017
MELISSA URIAN	AGENT	18453360	YES		08/30/2017
MATT MAHAFFEY	AGENT	15698016	YES		08/30/2017
KEVIN HOWELL	AGENT	1636526	YES		08/30/2017

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)	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:	MARY MACKEY
Title:	ACCOUNTING MANAGER
Phone Number:	330-920-8629
Email Address:	MARY@WICHERT.COM