Notification of Changes for Business Entity
General Information
Business Entity Name:	VALENTI TROBEC CHANDLER INC
Incorporation / Formation Date:	10/27/1980
FEIN:	382330200
Ohio License Number:	29376
NPN:	960075
DBA / Trade Name:	VTC INSURANCE GROUP
State of Domicile:	OH
County:	TROY
Business Address
Address 1:	1175 W LONG LAKE RD STE 200
Address 2:
City:	TROY
State:	MI
Zip:	48098
Phone:	2488283377
Fax:	2488284290
Business Web Site Address:
Business Email Address:	MCARRELL@VTCINS.COM
Mailing Address
Address 1:	1175 W LONG LAKE RD STE 200
Address 2:
City:	TROY
State:	MI
Zip:	48098
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	VTC INSURANCE GROUP
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	CHRISTY KRICK
Title:	LICENSING ADMINISTRATOR
Phone Number:	8124942472
Email Address:	CKRICK@SUPPORTIVEIS.COM