Notification of Changes for Business Entity
General Information
Business Entity Name:	THE GENERAL AUTOMOBILE INS SVCS INC
Incorporation / Formation Date:
FEIN:	62-1684225
Ohio License Number:	36214
NPN:	6539339
DBA / Trade Name:
State of Domicile:	CA
County:	SAN BERNARDINO
Business Address
Address 1:	4141 E INLAND EMPIRE BLVD #290
Address 2:
City:	ONTARIO
State:	OH
Zip:	91764
Phone:	800-280-1466
Fax:
Business Web Site Address:	WWW.THEGENERAL.COM
Business Email Address:	MBARNETT@THEGENERAL.COM
Mailing Address
Address 1:	2636 ELM HILL PIKE
Address 2:
City:	NASHVILLE
State:	TN
Zip:	37214
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
ADAMS, SCOTT D	PRODUCER	1879538	YES		12/27/2016
ARNOLD, MYRON L	PRODUCER	9005826	YES		12/27/2016
BARNETT, MEGAN ANNA	PRODUCER	15161440	YES		12/27/2016
BINDER, VICTORIA L	PRODUCER	1744844	YES		12/27/2016
BORES, DAVID R	PRODUCER	2828886	YES		12/27/2016
BOSZE, ROGER P	PRODUCER	1822181	YES		12/27/2016
BRAUN, DOUGLAS A	PRODUCER	2443862	YES		12/27/2016
BRYANT, RASHANN	PRODUCER	2432676	YES		12/27/2016
BUNCE, CORINNE LEE	PRODUCER	9146063	YES		12/27/2016
CARPENTER, CHAD	PRODUCER	17219489	YES		12/27/2016
CERVENAK, RAY	PRODUCER	7117726	YES		12/27/2016
CONGENI, AMY MARIE	PRODUCER	1784485	YES		12/27/2016
DENNISON, LUCY	PRODUCER	9025752	YES		12/27/2016
DRAKE, VERONICA ANN	PRODUCER	8911109	YES		12/27/2016
FERGUSON, MARK EDWARD	PRODUCER	16755635	YES		12/27/2016

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:	MEGAN BARNETT
Title:	LICENSING ADMIN
Phone Number:	800-257-0263 #3248
Email Address:	MBARNETT@THEGENERAL.COM