Notification of Changes for Business Entity
General Information
Business Entity Name:	GIBSON-MYERS & ASSOCIATES
Incorporation / Formation Date:
FEIN:	34-1137362
Ohio License Number:	601
NPN:	2827190
DBA / Trade Name:	ASSOCIATED UNDERWRITERS INSURANCE (AUI)
State of Domicile:	OH
County:	SUMMIT
Business Address
Address 1:	2876 S. ARLINGTON ROAD
Address 2:
City:	AKRON
State:	OH
Zip:	44312
Phone:	3306456338
Fax:
Business Web Site Address:	WWW.AUIINFO.COM
Business Email Address:	CMYERS@AUIINFO.COM
Mailing Address
Address 1:	2876 S. ARLINGTON ROAD
Address 2:
City:	AKRON
State:	OH
Zip:	44312
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:	ASSOCIATED UNDERWRITERS INS
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)	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:	CHRISTINE MYERS-JOHNSTON
Title:	TREASURER
Phone Number:	3306456338
Email Address:	CMYERS@AUIINFO.COM