Notification of Changes for Business Entity
General Information
Business Entity Name:	PEOPLES INSURANCE AGENCY LTD
Incorporation / Formation Date:
FEIN:	42-1356085
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	IA
County:	BREMER
Business Address
Address 1:	1700 8TH ST SW
Address 2:
City:	WAVERLY
State:	IA
Zip:	50677
Phone:	319-352-6085
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 119
Address 2:
City:	WAVERLY
State:	IA
Zip:	50677
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
RYAN MEESTER	AGENT	7704133	YES		12/19/2016
MATTHEW JANSEN	AGENT	6886608	YES		12/19/2016
AARON MIDDENDORF	AGENT	18099094	YES		12/19/2016
TODD BECKER	AGENT	16980036	YES		12/19/2016
KENNETH ANDERSON	AGENT	18200690	YES		12/19/2016
SCOTT WELSH	AGENT	18042882	YES		12/19/2016
SARAH LISENBEE	AGENT	15827465	YES		12/19/2016
JACI KRAMER	AGENT	15944955	YES		12/19/2016
JOHN LAESER	AGENT	17018293	YES		12/19/2016
MARK KIST	AGENT	16609520	YES		12/19/2016
JORDAN HASENKAMP	AGENT	16480698	YES		12/19/2016
ROBERT WHITINGER	AGENT	9624427	YES		12/19/2016
SONIA RODRIGUEZ	AGENT	17924954	YES		12/19/2016
BRONSON TATHAM	AGENT	17843220	YES		12/19/2016
BRET HANKS	AGENT	16362961	YES		12/19/2016

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:	JARVIS WHITINGER
Title:	OWNER
Phone Number:	319-352-6327
Email Address:	JARVIS@PEOPLES-INSURANCE.COM